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Background: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. Materials and methods: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant–Murley score) between the two groups of patients. Results: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). Conclusion: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it’s efficacy with that of traditional surgical intramedullary nail treatment. Materials and methods This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant–Murley score) between the two groups of patients. Results There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P

Introduction Strategical approaches to managing patients with a greater tuberosity fracture of the humerus are controversial and there are discussions about surgical treatment options. Nondisplaced fractures require no surgical management. Shoulder replacement can be indicated for the surgical treatment of proximal humeral fractures with limited function of the upper limb and difficulties in refixation of the rotator cuff tendons due to the peculiar anatomical location of the tendon fixation. Solution to this problem can improve the quality of life of patients with greater tuberosity fracture of the humerus. The objective was to evaluate the treatment outcome of a patient with a greater tuberosity fracture of the humerus repaired with open refixation of the rotator cuff tendons and medialization of the border of the articular surface of the humerus. Material and methods A 46-year-old patient presented with limited movements and severe pain in the left shoulder after humerus dislocation and a greater tuberosity fracture. Results The condition was repaired with an open repair of the rotator cuff tendons and medialization of the border of the articular surface of the humerus. The patient reported neither pain nor limited movements in the left shoulder at the one-year follow-up. Discussion Treatment options for patients with a greater tuberosity injury remains controversial. The effectiveness and results of organ-saving surgery have not been explored and require scientific evaluation using a larger cohort of patients. Conclusion Excellent functional results were achieved in a patient with injury to the greater tuberosity using surgical refixation of the rotator cuff tendons and medialization of the cartilaginous surface.

Case: A 10-year-old, postmenarchal girl presented to the emergency department with a closed, displaced, intercondylar T-type distal humerus fracture. Open reduction and internal fixation was performed 3 days following initial presentation. The patient healed but experienced elbow stiffness in the 7months following the procedure. Implant removal and capsular release were performed at that time. At the 31-month follow-up, the patient reported satisfactory elbow functionality. Conclusion: There is limited literature available discussing optimal management and associated outcomes of intercondylar T-type distal humerus fractures in the young-adolescent population. This report presents a possible method for management of the initial injury and the most common associated complication. [ABSTRACT FROM AUTHOR]

Background: To assess the functional outcome of PHILOS (proximal humerus internal locking system) plating in proximal humerus fractures. Materials and Methods: Twenty-five displaced fractures of proximal humerus (in twenty-five patients) treated with PHILOS(proximal humerus locking system) plate between MAY 2021 and APRIAL 2023. The study was conducted in department of Orthopedics & Traumatology Government General hospital, Rangaraya Medial College Kakinada, Andhra Pradesh, India. Patients between 18 to 49 yrs age with proximal humerus fractures. Results: The present study was done to evaluate functional out come and complication following surgical management of proximal humerus fracture by locking compression plate. (PHILOS PLATE). In PHILOS (proximal humerus internal locking system system) system of the threaded heads of the screws in the plate itself provides for a construct with angular and axial stability, eliminating the possibility of screw toggling or sliding of the screws in the plate holes. Coupled with a divergent or convergent screw orientation to head of humerus provide improved resistance to pull out and failure of fixation. Also, whereas conventional plating systems depend on compression between the plate undersurface and bone for stability, this is not the case for the locking plates. This lessens the chance of stripping the thread in osteoporotic bone, as the plate/bone interface is not loaded along the screw axis. This also allows for a more biological fixation as the underlying periosteum and blood supply to the fractured regions are much less compressed. Conclusion: In conclusion proximal humerus internal locking system (PHILOS) is mechanically and biologically an advantageous implant in proximal humeral fractures particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of low-frequency pulse electrical stimulation plus exercise therapy on nerve function recovery in patients with radial nerve palsy after humerus shaft fracture. Methods: A total of 110 patients with humerus shaft fracture and radial nerve injury admitted to our hospital from January 2017 to December 2021 were recruited. They were randomized to receive either conventional exercise therapy (control group) or conventional exercise therapy plus low-frequency pulse electrical stimulation (study group) according to the random number table method, with 55 cases in each. Clinical efficacy, muscle strength recovery, nerve conduction velocity (MCV), amplitude, wrist joint, and elbow joint activities of patients were analyzed and compared. Results: Patients with low frequency stimulation (LFS) showed significantly higher treatment effectiveness (89.09%) than those with exercise therapy only (69.09%). The incorporation of LFS with exercise therapy provided more enhancement in the muscle strength of wrist extensor and total finger extensor in patients when compared with a mere exercise intervention, suggesting better muscle function recovery of patients produced by LFS. Moreover, a significant increase in MCV and its amplitude was observed in all included patients, among which those receiving LFS showed a greater escalation of MCV and its amplitude. Following a treatment duration of 6 months, more patients in the LFS cohort were reported to achieve a wrist extension and elbow extension with an angle over 45° than the controls. There was no notable variance in adverse responses noted between the two patient groups. Conclusion: In patients afflicted with humerus shaft fracture and radial nerve injury, the amalgamation of exercise therapy with low-frequency pulse electrical stimulation can significantly improve clinical efficacy, promote nerve function, and muscle strength recovery, and features a high safety profile. Relevance to clinical practice: The combination of exercise therapy and low-frequency pulsed electrical stimulation can notably improve the promotion of neurologic function and muscle strength recovery in patients with humerus shaft fractures and radial nerve injuries with a high degree of safety. [ABSTRACT FROM AUTHOR]

Functional humeral bracing of midshaft humeral fractures has been widely accepted as a gold standard for nonoperative treatment. Despite reported high union rates, there is no proven superiority of any orthosis. Here we aim to compare the outcomes after the use of custom-made thermoplastic vs. commercial humeral brace with regard to time to union, nonunion rates, types of nonunion, and conversion to surgery. Patients with humeral fractures treated between 2018 and 2021 were identified retrospectively by electronic records. Only diaphyseal humerus fractures (AO 12) were included in the study. Proximal (AO 11) or distal (AO 13) fractures, open fractures, pathologic fractures, bilateral fractures, multiple fractures, and patients lost to follow-up were excluded. Patients attending one center received a custom-made thermoplastic splint, whereas those at the other center had an off-the-shelf humeral brace applied. Radiologic union was defined as healing of at least 3 of 4 cortices determined from follow-up radiographs. Data calculations were performed using the χ2 test. A total of 53 patients treated with a thermoplastic brace and 43 with a commercial brace were identified. A total of 52 men were included, and the cohort's mean age was 60.1 years (standard deviation: 16.1 years). Both groups had similar gender and age distributions. More patients achieved union with a thermoplastic brace (79.2%) than those with a commercial brace (76.7%), which was statistically significant (χ2, P =.04). Although time to union was similar both clinically and radiologically, patients with a commercial brace converted to surgical treatment more frequently (11 vs. 14 cases). Thermoplastic custom-made braces provide better fracture stability, allowing for statistically significantly higher rates of fracture union during a similar treatment period to commercially available splints. Patients wearing a commercial splint were significantly more likely to develop hypertrophic nonunion requiring surgery. [ABSTRACT FROM AUTHOR]

Abstract Introduction Fractures with delayed healing can be a serious complication, especially for athletes depending on quick return to sports. To our knowledge, no cases of increased healing of delayed union fractures with autologous biomedical interventions have been reported. Case presentation A 33-year-old Swedish professional boxer with a fractured humerus with a delayed union and a partially torn supraspinatus tendon was treated with injections of liquid platelet-rich fibrin and heat-coagulated albumin gel. He recovered almost completely from both injuries in only 1 month and could return to professional boxing in 3 months. Conclusion This case raises the hypothesis that liquid platelet-rich fibrin and heat-coagulated albumin gel may be an effective, minimally invasive intervention in fractures with a delayed union. Further research is required to test this theory.

Abstract Background Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study’s objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients. Materials and methods Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated. Results Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention. Conclusions Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims. Level of evidence Level I, prospective randomized case–control study.

Introduction Elbow trauma is common accounting for 40-50 % of all musculoskeletal injuries in children. From them, lateral condyle fractures are the second most common fractures in the pediatric elbow with complications ranging from 3.3 to 54.8 %. The objective was to determine the effectiveness of nonunion of the lateral humeral condyle (LHC) treated with bone grafts harvested from the patient's fibular shaft and the Ilizarov apparatus. Material and methods We report surgical treatment of bone defect repaired with bone graft and the Ilizarov apparatus in 57 children with nonunion of the LHC. Maintained articulation between the non-united bone and the radial head, magnitude and direction of displacement, visible resorption of the epimetaphysis, bone deficiency, malaligned upper limb, late ulnar neuritis were the parameters used for outcome assessment. Depending on the type of surgical treatment the patients were divided into 3 groups: Group 1 (n = 13) included patients who underwent open osteosynthesis and bone fixation using 2-3 Kirschner wires; Group 2 (n = 30) consisted of patients who underwent surgery to repair the bone defect between the humerus metaphysis and an non-united fragment of the LHC fixed with wires and immobilized with a cast; Group 3 (n = 12) included patients who were treated with bone graft followed by fixation of the bone and the graft using Ilizarov wires and frame. Two patients underwent supracondylar osteotomy. Results The outcomes were evaluated based on criteria to include non-union consolidation, joint function, limb alignment and condition of the growth plate. Long-term results were explored in 49 (85.9 %) patients out of 57 over a period of 6 months to 10 years. The results were rates as good in 39 (79.6 %) patients, as fair in 9 (18.36 %) and poor in one (2.04 %) case. Discussion Various types of operations are reported for non-united fractures and non-unions of the cervical spine to include surgeries from open osteosynthesis to complicated reconstructions. Conclusion Surgeries aimed at repair of bone defects using fibular autograft facilitated consolidation of non‑unions and engraftments.

Background: Open reduction and internal fixation with plate is one of the most widely used treatments for distal third humeral shaft fractures. The purpose of this study was to report the outcomes of the treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 22 distal third humeral shaft fractures treated with posterior MIPO in our institution with an extra-articular distal humerus plate from 2018 to 2021. Inclusion was limited to functionally independent patients with displaced fractures involving the junction of the middle and distal thirds of the humerus and minimum 12-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; Mayo Elbow Performance Score; and Constant-Murley score. Results: The average follow-up period of the sample was 31.7 ± 11.6 months (range, 15.7-51.3 months). The average elbow flexion and extension were 146.4° ± 7.3° (range, 120°-150°) and −0.7° ± 3.3° (range, −15° to 0°), respectively. The average shoulder anterior flexion, elevation, and abduction were 178.6° ± 3.6° (range, 170°-180°), 179.1° ± 2.9° (range, 170°-180°), and 140.9° ± 14.8° (range, 110°-160°), respectively. The average external rotation was 88.6° ± 6.4 (range, 65°-90°). The mean visual analog scale score for pain was 1.0 ± 1.6 (range, 0-5) and the mean Mayo Elbow Performance Score was 90.5 ± 9.9 (range, 70-100). The mean QuickDASH and Constant–Murley scores were 4.7 ± 6.8 (range, 0-20.5) and 95.5 ± 5.1 (range, 81-100), respectively. Two patients presented with relevant compromise of radial nerve motor function postoperatively (M3 and M2; the more compromised was preoperative injury). All patients recovered radial nerve neuropraxia within six weeks postoperatively. All fractures achieved union. The average anteroposterior and lateral axis were 175.0 ± 3.6 (168.0°-180.0°) and 177.5 ± 2.0 (173.0°-180.0°), respectively. No superficial or deep infection was reported. No cases of re-displacement of fracture, implant failure, or any other implant-related complication in follow-up were reported. No patient required plate withdrawal. Conclusion: The results of this study demonstrate that the posterior MIPO technique is a reliable option for treating distal third shaft humeral fractures. The radial nerve must be identified and protected in all cases to prevent palsy.

A female infant of a diabetic mother born through LSCS at 39 weeks of gestation with a birth weight of 2908 grams was noted to have a paucity of movement of the left upper limb soon after birth. The extremity was pale, had markedly deranged perfusion, and was cold to touch with absent brachial, radial, and ulnar arterial pulsations. There was a swelling noted over the middle of the left arm, which was tender and associated with crepitus suspicious of a fracture. The right upper limb and lower limbs were normal. An urgent X-ray of the left upper limb showed a displaced fracture of the left humerus fracture and the Doppler study revealed absent flow in the brachial artery distal to the fracture site without thrombus. Urgent close reduction of the fracture following which the doppler showed a thrombus in the brachial artery extending up to its bifurcation. The thrombosis was managed medically with low molecular weight heparin and aspirin. There was a gradual improvement of limb perfusion with normalcy achieved on day 3 of life with no residual complications even on follow-up. The workup of neonatal thrombosis, its immediate management and current evidence for the same have been discussed in detail. [ABSTRACT FROM AUTHOR]

Introduction: Fractures with delayed healing can be a serious complication, especially for athletes depending on quick return to sports. To our knowledge, no cases of increased healing of delayed union fractures with autologous biomedical interventions have been reported. Case presentation: A 33-year-old Swedish professional boxer with a fractured humerus with a delayed union and a partially torn supraspinatus tendon was treated with injections of liquid platelet-rich fibrin and heat-coagulated albumin gel. He recovered almost completely from both injuries in only 1 month and could return to professional boxing in 3 months. Conclusion: This case raises the hypothesis that liquid platelet-rich fibrin and heat-coagulated albumin gel may be an effective, minimally invasive intervention in fractures with a delayed union. Further research is required to test this theory. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study's objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients. Materials and methods: Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated. Results: Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention. Conclusions: Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims. Level of evidence: Level I, prospective randomized case–control study. [ABSTRACT FROM AUTHOR]

Abstract The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article. Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.

The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article. Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications. [ABSTRACT FROM AUTHOR]

Objective: Wrist wrestling is a sport in which two individuals position themselves on a table or a bar facing each other, with their elbows resting on the table, aiming to touch their opponent's hand to the table surface. Among adults participating in this sport, humerus shaft fractures are the most commonly observed injuries. In this study, our goal was to perform a systemic video analysis of humerus fractures occurring during wrist wrestling and to examine the mechanisms of these injuries. We assumed that identifying the positions commonly associated with injuries could be useful for injury prevention. Methods: On May 1, 2023, a search was conducted on YouTube using the terms "arm wrestling fracture," "arm wrestling humerus," and "arm wrestling humerus fracture." Inclusion criteria were videos clearly showing humerus fractures and allowing clear evaluation of athletes. Videos suspected of having humerus fractures, repeated videos, videos with unclear athlete evaluation, and videos not related to wrist wrestling were excluded. Authors examined body tilt nad rotation, coronal shoulder position, sagittal shoulder position, shoulder rotation, sagittal elbow position, coronal elbow position, forearm rotation and sagittal wrist position. Results: All 31 athletes included in the study were male. When examined for intra- and inter-observer agreement, it was observed to be nearly excellent (k=0.959, p<0.001; k=0.946, p<0.001). Out of the wrist wrestling matches, 19 (61.3%) were conducted with the athletes standing, while 12 (38.7%) were performed with them in a seated position. Conclusion: Humerus fractures occurring during wrist wrestling do not appear to be significantly influenced by the athlete's shoulder, elbow, and wrist positions or whether the athlete is standing or sitting. Body position and changes in the center of mass during the competition might be contributing factors to humerus fractures. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to review available literature on periprosthetic shoulder fractures to evaluate epidemiology, risk factors and support clinical decision-making regarding diagnostics, preoperative planning, and treatment options. Methods: Two authors cross-checked the PubMed and Web of Science medical databases. The inclusion criteria were as follows: original human studies published in English, with the timeframe not limited, and the following keywords were used: ‘periprosthetic shoulder fracture,’ ‘total shoulder arthroplasty periprosthetic fractures,’ ‘total shoulder arthroplasty fracture,’ and ‘total shoulder replacement periprosthetic fracture.’ Seventy articles were included in the review. All articles were retrieved using the aforementioned criteria. Results: The fracture rate associated with total shoulder arthroplasty varied between 0 and 47.6%. Risk factors for periprosthetic fractures were female gender, body mass index < 25 kg/m2, smoking, rheumatoid arthritis, and Parkinson’s disease. The most commonly used classification is the Wright and Coefield classification. Periprosthetic fractures can be treated both, conservatively and operatively. Conclusion: Periprosthetic fracture frequency after shoulder arthroplasty ranges from 0 to 47.6%. The most common location of the fracture is the humerus and most commonly occurs intraoperatively. The most important factor influencing treatment is stem stability. Fractures with stem instability require revision arthroplasty with stem replacement. Fractures with a stable stem depending on the location, displacement and bone stock quality can be treated both conservatively and operatively. For internal fixation plates with cables and screws are most commonly used.

Aim:Humeral shaft fractures are one of the most common fractures of the upper extremity. Most humeral shaft fractures can be treated conservatively, but in some cases, surgical treatment is required. In this study, the characteristics of patients who needed surgical intervention due to unsuccessful conservative treatment and inability to achieve union were investigated.Materials and Methods:Data of 67 patients [female (n=41) and male (n=26)] in whom conservative treatment was initiated due to humeral shaft fracture were evaluated retrospectively. The data of the patients in whom treatment had to be switched to surgery during the follow-up period were analyzed. Age, gender, trauma type, fracture site and vitamin D levels on the day of the fracture were noted.Results:At the end of 54 (42-77) days, the treatment was switched to surgery due to nonunion in 14 patients. All of these patients were female, over the age of 60 years, and the humeral fractures in these patients were in the middle third of the humerus. The mean 25(OH) vitamin D [25(OH) D] level of these patients was 14 mg/dL (4-22 mg/dL).Conclusion:It is concluded that the conservative treatment is prone to fail if humeral shaft fracture is a proximal oblique or a mid-shaft one, if the patient is over the age of 60 years and female, and if 25(OH)D level of the patient is low.

Objective: The aim of this study is to define the ideal surgical treatment option for distal humerus fractures by comparing different surgical techniques. Material and methods: Seventy-one patients with distal humerus diaphysis fractures who were treated between 2015 and 2020 were retrospectively investigated,. The patients were operated on with the posterior approach of open reduction and plate-screw osteosynthesis (Group A), plated with the minimal invasive technique (Group B), operated on using the lateral approach (Group C) and treated with an external fixator (Group D). Age, gender, mechanism of fracture, fracture type and AO class, applied surgical method, additional injuries, duration of operation, amount of bleeding, amount of fluoroscopy used, length of hospital stay, radiological angular values, union time, complications, and clinical examination findings of the patients were examined retrospectively and the differences between the mentioned surgical methods were investigated. Results: Blood loss was significantly less in Groups C and D (p

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Background: Patients with upper limb dysfunction from a brain injury often have different goals of treatment and expectations following a fracture of the upper extremity. This study retrospectively reviewed outcomes of nonoperative management of acute humerus fractures in patients with severe ipsilateral hemiparesis or hemiplegia. Methods: Patients who had sustained an acute humerus fracture managed nonoperatively, greater than 1 year following an upper motor neuron (UMN) injury resulting in ipsilateral severe hemiparesis or hemiplegia at a single tertiary care center from 1988 to 2019, were reviewed. Fractures were classified using the AO-Müller/Orthopaedic Trauma Association and/or Neer classifications. Primary outcome measures included House classification level of function, pain, achievement of and time to radiographic union, and the need for subsequent surgical procedures. Results: Ten distinct nonoperatively managed humerus fractures—3 proximal (11A23), 5 mid-shaft (12A2b = 1, 12A2c = 2, 12A3a = 1, 12A2b = 1), and 2 distal (13A2 = 1, 13 C1 = 1)—were identified in 8 patients (6 women and 2 men) with ipsilateral hemiparesis or hemiplegia. The median radiographic follow-up was 20 months (range: 78 days to 12 years). The median clinical follow-up was 33.5 months (range: 100 days to 12 years). All patients presented with severe pain that was absent at final follow-up. Radiographic union was achieved in all patients with a mean time to union of 90.9 ± 39.3 days (range: 35-185 days). No patients required operative management. Conclusions: Nonoperative management of humerus fractures in patients with an ipsilateral UMN injury might result in reliable pain relief and union without the need for further surgical intervention. Management of humerus fractures in this patient population should be individualized toward their goals of care. [ABSTRACT FROM AUTHOR]

Introduction: After centromedullary nailing (CMN) of 4-parts (4P) cephalo-tuberositary fractures of the proximal humerus (PH), shoulder immobilization for a few weeks is usual, although no scientific justification does support this attitude, nor the duration of immobilization. The objective of this study was to assess the impact of early mobilization after CMN of PH 4P fractures on clinical, radiological outcomes and complication rates. The hypothesis was that early mobilization would not lead to a deterioration in results or an increase in the complication rate. Materials and methods: All patients operated on for a 4P-PH fracture by CMN in our institution between 2010 and 2018 were included retrospectively. 2 groups were formed according to the duration of post-operative immobilization of the shoulder: 0–2 weeks (group A) and 3–6 weeks (group B). All patients had a clinical examination (Range of motion ROM and Constant score) and X-rays of the shoulder at least 24 months of follow-up. 58 patients (average age 66 years (39–89)) were included, with 25 in group A and 33 in group B. Results: The average follow-up was 38.5 (24–73) months. The active ROM at the last follow-up was: active anterior elevation 149° (80°–180°) in group A versus 134 (60°–180°) in group B (p = 0.099); active external rotation 145° (15°–70°) in group A versus 42° (15–70°) in group B (p = 0.6). The Absolute Mean Constant score was 78.29 for Group A (45–100) versus 68.59 points (45–96) for Group B (p = 0.065). Regarding complications: in group A, we found 2 retractile capsulitis, 2 pseudarthrosis and 2 osteonecrosis of the humeral head. In group B, we found 5 retractile capsulitis, 1 infection of the surgical site, 3 osteonecrosis of the humeral head and 1 pseudarthrosis. Conclusion: Early mobilization after CMN of 4P-PH fractures did not lead to an increase in the complications rate and in particular secondary displacements or osteonecrosis. There was a trend toward improved clinical outcomes with early mobilization, although this trend was not statistically significant. Evidence level: IV, retrospective study. [ABSTRACT FROM AUTHOR]

Introduction: Screw cut out and varus collapse are the most common complication of locked plate fixation of proximal humerus fractures. The purpose of this study was to compare dual plating and endosteal fibular allograft struts as augmentation strategies to prevent varus collapse. Materials and methods: A trapezoidal osteotomy was created at the metaphysis to create a 2-part proximal humerus model in 18 paired shoulder specimens. Each specimen was assigned to group A, B, or C and was fixed with either a lateral locking plate, a lateral locking plate and anterior one-third tubular plate in an orthogonal 90/90 configuration, or a lateral locking plate with intramedullary fibular strut, respectively. The specimens were stressed in axial compression to failure. Displacement, elastic limit, ultimate load, and stiffness were recorded and calculated. Results: There was no difference in mean cyclic displacement between the three groups (0.71 mm vs 0.89 mm vs 0.61 mm for Group A, B, C, respectively). Lateral plating demonstrated the greatest absolute and relative displacement at the elastic limit (5.3 mm ± 1.5 and 4.4 mm ± 1.3) without significance. The elastic limit or yield point was greatest for fibular allograft, Group C (1223 N ± 501 vs 1048 N ± 367 for Group B and 951 N ± 249 for Group A) without significance. Conclusions: Dual plating of proximal humerus fractures in a 90–90 configuration demonstrates similar biomechanical properties as endosteal fibular strut allograft. Both strategies demonstrate superior stiffness to isolated lateral locked plating. [ABSTRACT FROM AUTHOR]

Simultaneous ipsilateral fractures of the proximal and distal humerus, known as 'floating arm', are rarely seen in adolescents and are considered challenging to manage. Most of the published cases have involved proximal humerus and distal supracondylar fractures. This paper presents a special case of floating arm injury in a 14-year-old boy following a motor vehicle accident that was managed in a well-established trauma center. The injury consisted of displaced proximal humerus and open distal T-condylar intraarticular fractures. The patient was discharged in good condition and regained functionality with no reported complications. [ABSTRACT FROM AUTHOR]

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Purpose: The incidence of proximal humerus fractures (PHF) is rising and surgical intervention carries risk for fracture nonunion. The purpose was (1) to compare patient demographics of those that developed nonunion and (2) identify patient risk factors that predispose to nonunion following open reduction and internal fixation (ORIF) for PHF. Methods: A retrospective review of the Medicare Claims Database from 2005 to 2014 for patients who underwent primary ORIF for PHFs. Patients who developed nonunion were identified as the study group (n = 1020) and compared to a control group (n = 51,209). Primary endpoints were to compare demographics of the study group and the comparison cohorts and to identify patient-related risk factors associated with nonunion within 6-months following the index procedure. A logistic regression model was constructed to determine the association of comorbid conditions on developing a nonunion. A p value of 0.001 was the significance threshold. Results: Patients who developed nonunion were younger, more likely to be male, and had higher Elixhauser-Comorbidity Index scores (7 vs. 5; p < 0.0001) when compared with controls. Iron deficiency anemia (OR: 1.32; p = 0.0001), tobacco use (OR: 1.32; p = 0.0004), rheumatoid arthritis (OR: 1.29; p = 0.0001), depression (OR: 1.28; p = 0.0002), and BMI range from 30–39 kg/m2 (OR: 1.21; p = 0.001) were significant risk factors for nonunion. Conclusions: Certain patient risk factors including tobacco use, iron deficiency anemia, rheumatoid arthritis, depression, and a BMI in the range of 30–39 were associated with nonunion within 6 months of ORIF for PHF. This study may help in the risk stratification of these patients. [ABSTRACT FROM AUTHOR]

Background: The radial groove is known as a sulcus on the posterior humerus and protects the radial nerve from adjacent muscle and soft tissue. In the literature, there exists heterogeneity regarding the presence of an actual radial groove and the radial nerve's interaction with the periosteum of the humerus. This study aimed to determine if there is a real radial groove, "sulcus," and define the relationship between the radial nerve and the periosteum of the posterior humerus. Methods: Eighteen fresh-frozen cadaveric specimens were dissected using a posterior triceps splitting approach. The radial nerve's interaction with the periosteum of the humerus was determined. The presence of a visible and palpable radial groove was also examined. Results: In 56% of specimens, the radial nerve was directly seated over the periosteum of the posterior humerus (direct contact between the nerve and bone). In comparison, 44% of specimens had a layer of the medial head of the triceps brachii muscle fibers interposition between the nerve and bone. 89% of specimens had no visible or palpable radial groove. In 11% of specimens, there was mild palpable depression. Conclusion: This study shows that the radial groove may not exist and is probably not a true anatomical structure. In addition, the nerve is in direct contact with the posterior periosteum of the humerus in most specimens. These anatomic relationships and findings add to the anatomical understanding of the radial nerve, which helps during operative approaches and fixation of the humerus. [ABSTRACT FROM AUTHOR]

ObjectiveThis study sought to provide a national, descriptive analysis to determine fat embolism syndrome (FES) risk factors, hypothesizing that femur fractures and multiple fractures are associated with an increased risk.MethodsThe Trauma Quality Improvement Program was queried (2010-2016) for patients with extremity fractures. A multivariable logistic regression analysis model was used.ResultsFrom 324,165 patients, 116 patients (0.04%) were diagnosed with FES. An age ≤30, closed femur fracture, and multiple long bone fractures were associated with an increased risk of FES.ConclusionFuture research to validate these findings and develop a clinical risk stratification tool appears warranted.

Background: Safety zones to avoid nerve injury at proximal incision of posterior minimally invasive plate osteosynthesis for humerus fracture have been scarcely studied. The purpose of this study was to describe the location of axillary and radial nerves (RN) in magnetic resonance imaging to establish safety zones. Methods: Fifty-two magnetic resonance imaging studies of the entire humerus were reviewed. The mean age was 50.6 ± 12.1 years, with 37 female patients. The distance of the axillary nerve (AN; distal portion, humeral midpoint) and RN (medial border, midpoint, and lateral border of the humerus) was measured in relation to the posterolateral acromion angle, acromioclavicular axis, and transepicondylar axis. Univariate analysis (Student’s t test) and a multivariate analysis (linear regression) were performed. P values < .05 were considered significant. Results: The AN location at the humerus was 54.9 ± 6.4 mm (20.1% humeral length [HL]) in relation to posterolateral acromion angle and 63.2 ± 6.1 mm (23.2% HL) in relation to acromioclavicular axis. The RN location was 100.2 ± 17.1 mm (36.6% HL) at the humerus medial border, 118.0 ± 21.5 mm (43.1% HL) at the humerus midpoint, and 146.0 ± 24.4 mm (53.6% HL) at the humerus lateral border. In relation to transepicondylar axis, it was 175.4 ± 15.6 mm (64.3% HL), 156.0 ± 19.0 mm (57.2% HL), and 127.4 ± 21.2 mm (46.7% HL), respectively. Nerves location was related to HL, independent of gender. Conclusion: The main finding of our study is that the location of the AN and RN in relation to the humerus is related to the HL and can be used to predictably define the safe zones to avoid nerve injury in the proximal incision of posterior minimally invasive plate osteosynthesis for humerus fractures.

Background Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. Methods A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. Results Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. Conclusions With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results.

Background. Fractures of the proximal humerus are common injury, especially among older age group patients. For the treatment of most cases, conservative tactics are required, some require surgery: osteosynthesis, arthroplasty. Proximal humerus fractures with extension to the metadiaphyseal and diaphyseal zones uncommon, and treatment of this type of injuries is complex for trauma surgeons. The aim of the study is to demonstrate successful experience of two-stage treatment of the proximal humerus fracture with extension to the diaphysis middle third in an older age group patient. Case presentation. The clinical case presents successful two-stage treatment of the proximal humerus fracture with extension to the middle third of the diaphysis in an older age group patient. The first stage was performed osteosynthesis of the humerus with the PHILOS Long plate, the second stage reverse shoulder arthroplasty. Conclusion. Consistent performing of osteosynthesis and total reverse shoulder arthroplasty allows to achieve satisfactory treatment results with restoration of the injured limb function and relief of pain syndrome.

Background: Open reduction and internal fixation (ORIF) of humeral head split fractures is challenging because of high instability and limited visibility. The aim of this retrospective study was to investigate the extend of the approach through the rotator interval (RI) on the reduction quality and functional outcome. Methods: 37 patients (mean age: 59 ± 16 years,16 female) treated by ORIF through a standard deltopectoral (DP) approach were evaluated. The follow-up period was at least two years. In 17 cases, the approach was extended through the RI. Evaluation was based on radiographs, Constant scores (CS) and DASH scores. Results: In group DP, "anatomic" reduction was achieved in 9 cases (45%), "acceptable" in 5 cases (25%), and "malreduced" in 6 cases (30%). In group RI, "anatomic" reduction was seen in 12 cases (71%), "acceptable" in 5 cases (29%), and "malreduced" in none (p = 0.04). In the DP group, the CS was 60.2 ± 16.2 and the %CS was 63.9 ± 22.3, while in the RI group, the CS was 74.5 ± 17.4 and the %CS was 79.1 ± 24.1 (p = 0.07, p = 0.08). DASH score was 22.8 ± 19.5 in DP compared to RI: 25.2 ± 20.6 (p = 0.53). Conclusions: The RI approach improves visualization as it enhances quality of fracture reduction, however functional outcomes may not differ significantly. Type of study and level of proof: Retrospective, level III [ABSTRACT FROM AUTHOR]

Atrial Septal Defect is most common congenital developmental acyanotic cardiac anomaly. There is left to right shunt of blood in normal compensated state. In decompensated state, the shunt is reversed and flow is from right to left side causing heart failure and thrombo-embolic event. Here, we report a case of Humerus fracture with large ASD, managed under General Anaesthesia with Interscalene block without any deleterious effects like Venous Air Embolism, Spontaneous Reversal of Shunt etc. As patient was in Beach chair position.

A dog was presented to the University Veterinary Hospital, Kokkalai with a history of nonweight bearing lameness on left forelimb and was diagnosed as humerus fracture. Supracutaneous locking compression plating was carried out after open reduction under general anaesthesia. Periodic clinical and radiographic evaluations were conducted at two weeks interval for a period of six weeks until the plate removal. Physiological and haematological parameters were within the normal range. The serum alkaline phosphatase level was high at the time of presentation and decreased progressively. The dog returned to sound gait, normal weight bearing and satisfactory functional limb usage by sixth post operative week. The fracture healed with periosteal and endosteal callus. The implant was intact and patient acceptance was satisfactory throughout the observation period.

Supracondylar humerus fractures (SCHF) are rarely seen in the youngest age groups (1-3 years). Although there is no difference in the context of treatment options, it has been shown that younger age groups have different characteristics. Few studies have examined toddlers, which have notably different characteristics. This study is the first to report the characteristics, diagnosis, treatment and functional results of SCHF in infants and early toddlers. A retrospective analysis was made of the data of patients younger than 30 months old, who were operated on in our clinic for SCHF between 2012 and 2020 with at least 2 years of follow-up. Patient demographic and surgical data, and the functional and radiological results were documented. Evaluation was made of a total of 52 patients comprising 30 females (58%) and 22 males (42%), with a mean age of 20.75 ± 5.4 months (range, 6-30 months). The injury was in the right elbow in 24 (46%) patients. The mechanism of injury was a fall from an object at home (table, chair, bed, etc.) in 41 (79%) patients. Patients who fell from a height of more than 4 meters had additional injuries (liver laceration, vertebral fracture, etc.). Only 1 patient had anterior interosseous nerve (AIN) damage before the operation, but the final follow-up neurovascular examinations for all patients were normal. The median follow-up period was 4 years (range, 2-7 years). Flynn outcome scores were (88.5%) excellent and variant Hospital for Special Surgery scores were (82.7%) excellent. With appropriate treatment of SCHF, the clinical outcomes in infants and early toddlers are excellent. Using a medial pin to achieve and protect stability in this age group does not increase the risk of iatrogenic ulnar nerve damage. Patients younger than 20 months tend to have more varus malalignment but similar functional results. [ABSTRACT FROM AUTHOR]

Proximal humerus fractures are the third most common fractures, totaling 4% to 5% of all fractures. Here, we present the case of a 39-year-old man with a dislocated four-part fracture of the proximal humerus with a huge bony Bankart lesion. Preoperatively, the bony Bankart lesion of the glenoid was not visualized on computed tomography scans or magnetic resonance imaging because the fracture of the proximal humerus was comminuted, displaced, and complex. It was planned for only the humerus fracture to be treated by open reduction and internal fixation using a locking plate. However, a fractured fragment remained under the scapula after reduction of the dislocated humeral head. This was mistaken for a dislocated bone fragment of the greater tuberosity and repositioning was attempted. After failure, visual confirmation showed that the bone fragment was a piece of the glenoid. After reduction and fixation of this glenoid part with suture anchors, we acquired a well-reduced fluoroscopic image. Given this case of complex proximal humerus fracture, a glenoid fracture such as a bony Bankart lesion should be considered preoperatively and intraoperatively in such cases.

INTRODUCTION: There is controversy about the treatment of proximal humeral fracture (PHF) in elderly patients. Surgery should be considered especially for comminuted and advanced displacement fractures. Due to factors such as osteoporosis caused by advanced age, locked proximal humeral plates (LPHP) with good bone involvement are preferred. We examined the results of the LPHP that we applied for PHF over 60 years. METHODS: Patients with PHF over the age of 60 were included in the study. Patients underwent open reduction with a deltopectoral incision and osteosynthesis with a LPHP. Patients are followed up for at least 1 year radiologically and clinically. After the first year, our patients were evaluated according to the Constant-Murley shoulder score (CMSS) and complications were followed up. RESULTS: 31 patients with PHF who were operated on by us were included in our study (25 females,6 males). The mean age is 71.22(62-87). Our patients; According to the Neer classification, 1 has 1-part,13 has 2-part,12 has 3-part, 5 has 4-part and 3 has fracture-dislocations. Mean follow-up time: 13.9(12-18) months. Average union time: 13.55 weeks(12-20). The mean CMSS was found to be 49.74(23-98). There was no significant difference between the CMSS of patients above and below 70 years. No significant difference was found between the CMSS of Neer type 1,2 and 3,4 patients. DISCUSSION AND CONCLUSION: Since locked humeral plate application in patients with PCC over 60 years is prone to complications and poor functional results,we think that it would be appropriate to plan the surgeries accordingly by considering alternative treatment options for these patients.

Abstract Background Posttraumatic shoulder stiffness remains a problem after proximal humerus fracture (PHF) despite good healing rates. The aim of this pilot study was to determine whether the implant material and overlying soft tissue have an effect on shoulder range of motion (ROM) before and after implant removal (IR). Methods 16 patients (mean age 55.2 ± 15.3 (SD) years; 62.5% female) were included who underwent operative treatment with locking plates of either carbon fiber reinforced Polyetheretherketone (PEEK) (PEEKPower® humeral fracture plate, Arthrex, Naples, Florida, USA, n = 8) or titanium alloy (Ti) (Philos®, DePuy Synthes, Johnson & Johnson Medical, Raynham, Massachusetts, USA, n = 8) for PHF. All patients presented with a limited ROM and persistent pain in everyday life after the fracture had healed, whereupon IR was indicated. ROM before and after IR were compared as well as the Constant Score (CS) and the CS compared to the contralateral shoulder (%CS) 1 year after IR. Results In group PEEK, elevation was 116.3° ± 19.2° pre- and 129.4° ± 23.7° post-IR (p = 0.027). External rotation was 35.0° ± 7.6° pre- and 50.6° ± 21.8° post-IR (p = 0.041). External rotation with the humerus abducted 90° was 38.8° ± 18.1° pre- and 52.5° ± 25.5° post-IR (p = 0.024). In group Ti, elevation was 110.0° ± 34.6° pre- and 133.8° ± 31.1° post-IR (p = 0.011). External rotation with the humerus at rest was 33.8° ± 23.1° pre- and 48.8° ± 18.7° post-IR (p = 0.048). External rotation with the humerus abducted 90° was 40.0° ± 31.6° pre- and 52.5° ± 22.5° post-IR (p = 0.011). Comparison of the two implant materials showed no significant difference. The overall CS was 90.3 ± 8.8, the %CS was 91.8% ± 14.7%. Conclusion There was no significant difference in ROM, CS and %CS with respect to plate materials, although lower cell adhesion is reported for the hydrophobic PEEK. However, all patients showed improved functional outcomes after IR in this pilot study. In patients with shoulder stiffness following locked plating for PHF, implants should be removed and open arthrolysis should be performed, independently from the hardware material. Level of evidence II

A trauma is needed to produce a humerus fracture, such as: accidents, falls, strong impact, overload. The most common symptoms in humerus fracture and which need to be analyzed are: pain, edema, bruising. Humerus fractures are diagnosed in most cases based on physical examination and a bone x-ray [2,5,11,13]. In this study, we began from the hypothesis that by using kinetic means, the patient with humeral fracture can be recovered in the best conditions. The recovery program should be started as early as possible, and should be indicated immediately after immobilization, to prevent complications [1,4,6,12]. Throughout this study, we considered the implementation of the proposed objectives from the beginning and also verification of the hypothesis from which we started. In order for the physiotherapy program to be carried out in optimal conditions, we followed a series of principles.

Introduction and Objective: Proximal humerus fractures with metaphysodiaphyseal extension represent a challenge for the orthopedic surgeon due to their reduced incidence and the difficulty in the treatment decision. These can be treated with an intramedullary nail or using the MIPO technique, associating different advantages and complications depending on the procedure. The objective of this study was to compare metaphyseal-diaphyseal fractures of the humerus treated with antegrade intramedullary nailing and those operated using the MIPO technique to see if there were significant differences in terms of functional, clinical, and radiological results.Material and Methods: retrospective, analytical and unicentric review of 29 patients with proximal fracture with metaphyseal-diaphyseal extension treated by MIPO technique and 33 patients surgically treated by antegrade intramedullary nailing (IMN) in our hospital from 2014 to 2020. Demographic, functional, radiographic and clinical data were obtained..Results: No significant differences were observed between both groups in terms of fracture mechanism (p=0.34), fracture type (p=0.13) or Maresca classification (p=0.32). Surgical time was significantly shorter in the IMN group compared to the MIPO technique (p=0.014). No significant difference was observed regarding the need for blood transfusion (p=0.32). The mean consolidation in the MIPO group was 21 weeks compared to 21 weeks in the IMN, with no significant differences between both groups (p= 0.88). No significant differences were observed between CONSTANT test at one year in the MIPO group versus the IMN group (p=0.79), nor in radial nerve palsies (p=0.28).Conclusions: Proximal fractures with metaphyseal-diaphyseal extension are a challenge for the orthopedic surgeon due to the infrequency, the complexity of these fractures and the fact that there is no established consensus on the ideal treatment for this type of injury. Both the MIPO technique with the Philos plate and the intramedullary nail are valid options for the treatment of these fractures, with no differences observed in terms of fracture consolidation time or in terms of functional results. [ABSTRACT FROM AUTHOR]