Abstract
Introduction
This study aims to describe the results of plate fixation in one of the largest single-center cohorts that employs plate fixation as the golden standard. Additionally, risk factors related to a negative outcome were identified.
Materials and methods
This was a retrospective cohort study of all patients treated for a humeral shaft fracture in a level-one trauma center between January 2010 and December 2017 with a mean follow-up of 1 year.
Results
Plate fixation was performed in 102 patients with a humeral shaft fracture. The mean age was 50 (SD 20) years with 54.9% (n = 56) being male. Forty-eight percent (n = 48) had an AO type-A, 34.3% (n = 35) type-B, and 18.7% (n = 19) type-C fracture. Deep surgical site infections and non-union occurred in 1% (n = 1) and 3.9% (n = 4) of patients, respectively. Revision of the implant was performed in 15.7% (n = 16) mainly due to implant-related complaints. Only one patient developed radial nerve palsy after surgery. The median duration to radiological fracture healing and full-weight bearing was 18 (range 7–65) weeks and 14 (range 6–56) weeks, respectively. Risk factors for negative outcome included higher age, osteoporosis, open and higher AO class fractures, performing surgery during out-office hours, and the use of LCP 3.5-mm plate and an anterolateral approach.
Conclusion
Plate fixation for humeral shaft fractures has low risks of complications. It should be emphasized that the complications can be further minimized with a greater surgical expertise and by refraining from performing a surgery during out-office hours.
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References
Ekholm R, Adami J, Tidermark J et al (2006) Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Jt Surg Br 88(11):1469–1473
Hohmann E, Glatt V, Tetsworth K (2016) Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 25(10):1634–1642
Zarkadis NJ, Eisenstein ED, Kusnezov NA et al (2018) Open reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: an expected value decision analysis. J Shoulder Elbow Surg 27(2):204–210
Kurup H, Hossain M, Andrew JG (2011) Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005959.pub2
Lopiz Y, Garcia-Coiradas J, Garcia-Fernandez C, Marco F (2014) Proximal humerus nailing: a randomized clinical trial between curvilinear and straight nails. J Shoulder Elbow Surg 23(3):369–376
Gottschalk MB, Carpenter W, Hiza E et al (2016) Humeral shaft fracture fixation: incidence rates and complications as reported by American board of orthopaedic surgery part II candidates. J Bone Jt Surg Am 98(17):e71
Von Elm E, Altman DG, Egger M et al (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499
Smith J, Shoukri K (2000) Diagnosis of osteoporosis. Clin Cornerstone 2:22–33
The ATLS Subcommittee and the International ATLS working group AC of SC on T (2013) Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg 74:1363–1366
Cuthbert SC, Goodheart GJ (2007) On the reliability and validity of manual muscle testing: a literature review. Chiropr Osteopat 15:4
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063
Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746
Health Protection Agency (2006) Surveillance of surgical site infection in England: October 1997–September 2005. Health Protection Agency, London
Birkmeyer JD, Stukel TA, Siewers AE et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127
Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94(2):145–161
Wang Q, Hu J, Guan J, Chen Y, Wang L (2018) Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model-a retrospective study. J Orthop Surg Res 13(1):203
Beeres FJP, Hallensleben NDL, Rhemrev SJ, Goslings JC, Oehme F, Meylaerts SAG et al (2017) Plate fixation of the proximal humerus: an international multicentre comparative study of postoperative complications. Arch Orthop Trauma Surg 137(12):1685–1692
Gausden EB, Christ AB, Warner SJ et al (2016) The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications. Arch Orthop Trauma Surg 136(12):1683–1689
Kumar BS, Soraganvi P, Satyarup D (2016) Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach. Malays Orthop J 10(1):38–43
Pearson RG, Clement RG, Edwards KL et al (2016) Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open 6(11):e010303
Hak DJ, Fitzpatrick D, Bishop JA et al (2014) Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury 45(Suppl 2):S3–7
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van de Wall, B.J.M., Ganzert, C., Theus, C. et al. Results of plate fixation for humerus fractures in a large single-center cohort. Arch Orthop Trauma Surg 140, 1311–1318 (2020). https://doi.org/10.1007/s00402-019-03319-z
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DOI: https://doi.org/10.1007/s00402-019-03319-z