Journal of Musculoskeletal Trauma

Minimally Invasive Anterior Plating of Humeral Shaft Fractures: Hyun Joo Lee, Chang Wug Oh, Do Hyung Kim, Kyung Hyun Park; J Korean Fract Soc 2011;24(4):341-346. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.341

PURPOSE
We evaluated the efficacy and results of minimally invasive anterior plating for humeral shaft fracture.
MATERIALS AND METHODS
Twenty-two cases of humeral shaft fracture were reviewed, including 8 cases of type A, 8 of type B and 6 of type C (AO/OTA classification). There were three open fractures. The fracture was fixed with MIPO (minimally invasive plate osteosynthesis) technique under C-arm guide. A locking compression plate was located in anterior aspect of the humerus with at least three screws fixed in each fragment. Radiologic and functional results were evaluated.
RESULTS
In 20 of 22 cases, bony union was achieved with the mean period of 17.5 weeks, including 2 cases of delayed union. There were 2 cases of nonunion, which needed the further operative procedure. Except one case of distal 1/3 fracture, all cases showed satisfactory elbow and shoulder function with the mean Mayo elbow score of 17.4 and mean UCLA shoulder score of 97.3. In complication, there was one case of radial nerve palsy due to improper traction, but it was completely improved after 3 months. Otherwise, there was no complication including infection.
CONCLUSION
Anterior MIPO for humeral shaft fracture may be another option of operative methods with high union and low complication rate.

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Minimal Invasive Plate Osteosynthesis versus Conventional Open Plating in Simple Humeral Shaft Fracture (AO Type A, B1, B2)
Boseon Kim, GwangChul Lee, Hyunwoong Jang
Journal of the Korean Fracture Society.2017; 30(3): 124. CrossRef
Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
Operative Treatment of Humerus Shaft Fracture: Conventional Open Plating or Minimally Invasive Plate Osteosynthesis
Hyun-Joo Lee, Chang-Wug Oh
Journal of the Korean Fracture Society.2012; 25(2): 155. CrossRef

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Dislocation of the Shoulder with Ipsilateral Humeral Shaft Fracture: A Case Report: Chul Hyun Cho, Kwang Yeung Jeong; J Korean Fract Soc 2010;23(4):382-385. Published online October 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.4.382

Abstract PDF

Dislocation of the shoulder with ipsilateral humeral shaft fracture is very rare, but serious injury that requires emergent care. There have been approximately 20 cases reported in the English literature, but it has never been reported in Korea. We report a case of dislocation of right shoulder with ipsilateral humeral shaft fracture which was successfully treated by closed reduction of the shoulder under general anesthesia and internal fixation with antegrade interlocking intramedullary nailing for the humeral shaft fracture.

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Anterior Shoulder Dislocation With an Ipsilateral Humeral Shaft Fracture: A Case Report
Abdulmalik B Albaker , Ahmad Abdullah A Alsaleh, Mishari Malik Alshammari, Hatim Abdullah Akkasi, Hazzaa Abdullah Hazza Alharbi, Norah Ibrahim S Alqurmulah
Cureus.2023;[Epub] CrossRef

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Operative Treatment of Traumatic Humeral Shaft Fracture: Comparision of Interlocking IM Nailing and Plate Fixation by Posterior Approach: Hyun Dae Shin, Kwang Jin Rhee, Kyung Cheon Kim, Ho Sup Song; J Korean Fract Soc 2005;18(2):93-99. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.93

Abstract PDF

PURPOSE
To compare the results and complications of interlocking IM nailing and plate fixation by posterior approach in the treatment of traumatic humeral shaft fracture MATERIALS AND METHODS: From March 1997 to March 2003, 49 patients undergone operation due to traumatic humeral shaft fracture. Follow-up was over one year. 28 patients operated with interlocking IM nailing initially and 21 operated with plate fixation by posterior approach prospectively. Statistics were compared using clinical and radiological outcomes and complications.
RESULTS
Radiologically, bone union was observed after an average of 14.3 weeks in IM nailing, and 11.7 weeks in plate fixation. So plate fixation showed earlier bone union (p=0.012). Nonunion occurred in 4 cases (14.3%) operated with IM nailing, and 1 case (4.8%), that was open shaft fracture, with plate fixation. Nonunion occurred more frequently when operated by IM nailing. 6 cases showed limitation of shoulder movement due to damage of the rotator cuff by IM nail entry site. 1 case showed radial nerve palsy, and 1 case showed axillary nerve palsy in the case of IM nailing. Also, secondary surgery due to complications was operated in 9 cases (32.1%) in IM nailing and 1 case (4.8%) in plate fixation (p=0.03).
CONCLUSION
In the case of traumatic humeral shaft fracture plate fixation by posterior approach was more useful than IM nailing in the decrease of complications and bone union. Such approach is thought to be an excellent method for anatomic reduction and nerve exploration in the case of open and comminuted fracture which accompany nerve injuries

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Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
Minimally Invasive Anterior Plating of Humeral Shaft Fractures
Hyun-Joo Lee, Chang-Wug Oh, Do-Hyung Kim, Kyung-Hyun Park
Journal of the Korean Fracture Society.2011; 24(4): 341. CrossRef
Result of Interlocking Intramedullary Nailing for Humeral Shaft Fracture Evaluation of Post-operative Shoulder Function
Seung Rim Park, Tong Joo Lee, Ryuh Sub Kim, Kyoung Ho Moon, Dong Seok You
Journal of the Korean Fracture Society.2007; 20(2): 166. CrossRef

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Lateral Approach for Internal Fixation of the Distal Humeral Shaft Fractures: Seung Koo Rhee, Joo Yup Lee, Yoo Joon Suh, Joon Ho Lee, Nong Kyoum Ahn; J Korean Fract Soc 2004;17(2):83-89. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.83

Abstract PDF

PURPOSE
To investigate the efficacy and advantages of the lateral approach for internal fixation of the distal humeral shaft fractures.
MATERIALS AND METHODS
Twelve patients with distal humeral shaft fractures who underwent open reduction and internal fixation using plate and screws by lateral approach from January, 1997 to May, 2002 were investigated. Postoperative results after a minimum 1 year follow-up were assessed using union rate, elapsed time to union, postoperative complications such as iatrogenic radial nerve palsy, range of motion of the elbow joint. Clinical outcomes were evaluated with Mayo elbow performance scoring system.
RESULTS
Union was achieved in all cases. The average time to union was 9 weeks (range, 7~12 weeks). Four cases of preoperative radial nerve palsy were revealed as contusion of the intact nerve and resolved completely by three months. The mean elbow range of motion was from 5 to 138 degrees. The average Mayo elbow performance score was 91 points; 9 cases ranked as excellent and 3 as good.
CONCLUSION
Distal humeral shaft fractures can be treated successfully through open reduction and internal fixation using plate and screws. Lateral approach is recommended to stabilize distal humeral shaft fractures without compromising the range of motion of the elbow, and to protect or explore the injured radial nerves easily

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Modified anterolateral approach for internal fixation of Holstein–Lewis humeral shaft fractures
Ho Min Lee, Young Sung Kim, Suk Kang, Min Young Lee, Jong Pil Kim
Journal of Orthopaedic Science.2018; 23(1): 137. CrossRef
Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef

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Operative Treatment of the Humeral Shaft Fracture: Comparative Study of Dynamic Compression Plate and Interlocking Intramedullary Nail: Jeung Tak Suh, Sung Won Jung, Ja Kyung Ku, Chong Il Yoo; J Korean Soc Fract 2002;15(3):391-397. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.391

Abstract PDF

PURPOSE
We have followed up the patients of the humeral shaft fracture who had been treated with dynamic compression plate or locked intramedullary nail, which are common therapeutic options, compared them and analyzed results and complications.
MATERIALS AND METHODS
We analyse the clinical results, radiological results and complications of 50 cases of the humeral shaft fracture who were treated with dynamic compression plate(DCP) or intramedullary nail(IMN) at the Pusan National University Hospital from March in 1996 to February in 2001.
RESULTS
We find the no significant difference in range of motion of the shoulder, infection, operation time, operative bleeding loss and second radial nerve palsy but 4 cases of shoulder pain and 1 case of shoulder impingement in IMN group. We find the no significant difference in mean bone union time in both groups but 2 cases of nonunion in DCP group and 4 cases of nonunion in IMN group. Complications happened in 4 case of DCP group (total 26 cases) and 2nd surgery was needed in 3 cases(11.5%). However complications happened in 10 cases of IMN group (total 24 cases) and second surgery was needed in 6 cases(25%).
CONCLUSION
The treatment results of the humeral shaft fracture with dynamic compression plate is much better than intramedullary nail except specific pathologic or segmental fracture pattern.

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COMPARATIVE STUDY OF COMPRESSION PLATING VS. INTERLOCKING NAIL IN FRACTURE SHAFT OF HUMERUS
Rajeev Kumar Roy, Mahesh Prasad
Journal of Evidence Based Medicine and Healthcare.2017; 4(41): 2481. CrossRef
Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef

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The Comparison of the Using of Plate Fixation and Interlocldng IM Nailing in Humeral Shaft Fracture: Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Min Yong Kim; J Korean Soc Fract 2001;14(4):720-725. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.720

Abstract PDF: PURPOSE
This study was to evaluate the results and the usefulness of the plate fixation and the interlocking IM nailing for the humeral shaft fractures.
MATERIALS AND METHODS
We have reviewed thirty cases of humeral shaft fractures, which were treated with plate fixation in seventeen cases and interlocking IM nailing in thirteen cases in period of February 1993 to May 1999. The Russel-Taylor nails were used in all cases for interlocking IM nailing. The clinical and the radiological results were evaluated after operation.
RESULTS
The average union time was 14.5 weeks for the plate fixation and 15.2 weeks for the interlocking IM nail respectively. There were two cases of wound infection and one case of radial nerve injury for the plate fixation, and two cases of rotator cuff injury on the shoulder were found after the interlocking IM nailing.
CONCLUSION
Interlocking IM nailing is a relatively simple procedure with low rate of infection and radial nerve injury, but rotator cuff injury is a considerable problem after operation.

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Treatment of Humeral Shaft Nonunion after Primary Internal Fixat: Kwang Won Lee, Kyou Hyeun Kim, Whoan Jeang Kim, Ha Yong Kim, Jae Hoon Ahn, Yong Bum Park, Won Sik Choy; J Korean Soc Fract 1999;12(3):704-711. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.704

Abstract PDF: We retrospectively reviewed one hundred fifty-two patients who were treated for humeral shaft fractures at Eul-Ji Medical College hospital from Jan 1991 to June 1997. We experienced twenty one cases of nonunion among them after primary internal fixation. The purpose of this study was to evaluate possible causes of nonunion and to find out adequate treatments. The main cause of nonunion was an inadequate fixation (57%). The most common fracture pattern was simple transverse type(22%), and it occurred most frequently at the middle one third area of humeral shaft(22%). For the treatment of nonunion, the plate fixation was done in ten cases, interlocking intramedullary nailing in three cases, bone graft only in six cases, and external fixation using monofixator(Orthofix) in two cases. We obtained complete bony union from all cases, and the average union time was 17.5 weeks. Our study showed that higher incidence of nonunion was found in primary intramedullary nailing cases(19%) than in primary plate fixation cases(4%). In conclusion, close attention should be paid when choose the primary fixation method, and plate fixation and bone graft was considered as one of the useful treatment method of nonunion.

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Treatment of Humeral Shaft Fracture with AO Unreamed Humeral Nail: In Heon Park, Kee Byoung Lee, Kyung won song, Jin Young Lee, Min Choi; J Korean Soc Fract 1999;12(2):429-434. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.429

Abstract PDF: We performed a retrospective study of nine humeral shaft fractures which were treated by interlocking intramedullary nailing, the AO UHN (Unreamed Humeral Nail) system between March 1996 and February 1997 with more than one year of follow up. AO UHN inserted by either antegrade or retrograde technics through limited incisions followed by insertion of 2 proximal and distal Interlocking screws. Compression between fractured fragments was achieved in the non-comminuted and indicated cases. Immediate postoperately, soft shoulder immobilizer was applied and rehabilitation was started with active shoulder motion exercise few days to 1 week postoperately as soon as patient could tolerate pain. Union occurred at average of 13 weeks except one expired case with pathologic fracture due to advanced metastatic cancer. Pain relief and functional restoration were rated as good to excellent in most cases. Interlocking intramedullary nailing using AO UHN for the humeral shaft fractures usually provides immediate stability of the fracture and can be accomplished with a closed technique, minimum morbidity, with a resultant early return of function of the extremity. Therefore we recommend AO UHN for the treatment of the humeral shaft fractures if available without hesitation.

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Complications of Interlocking Intramedullary Nailing for the Humeral Shaft Fractures: Choong Gil Lee, Jin Woo Kwon, Kyoung Tae sohn, Seung Ho Shin, Jong Cheon Park; J Korean Soc Fract 1998;11(2):254-261. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.254

Abstract PDF: Locked intramedullary nailing has been used as a popular method in treating humeral shaft fracture because of relatively less invasive procedure, good stability and allowing early rehabilitation. However many problems such as rotator cuff injury, iatrogenic fracture, difficult distal locking at operation and painful limitation of shoulder motion due to protrusion of the nail above the greater tuberosity, frequent delayed or nonunion were reported. We reviewed our experience with 26 cases of humeral shaft fractures that were treated by interlocking intramedullary nailing to evaluate the pitfalls and the complications of this technique. the results were as follows. 1. In five cases(19.2%) iatrogenic fractures occured during nail insertion. Three were in the site of inlet and two were in the original fracture site. 2. In four cases(15.4%) painful limitation of shoulder motion was persisted for 2 months. Two were caused by subacromial impingement due to nail protrusion and two were by intraoperative rotator cuff injury. 3. Nonunion occured in two cases(7.7%) which were middle one third transverse fractures and were not fixed with distal locking screws. 4. Intraoperative and postoperative complication rate was 42.3%.

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Complications of Interlocking Intramedullary Nailing for the Humeral Shaft Fracture: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jong Keon Oh, Sang Hun Ko, Seung Wook Jeong; J Korean Soc Fract 1997;10(3):669-677. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.669

Abstract PDF: Several advantages of intramedullary nails over plates and external fixators have led to an anpansion of the surgical indications for humeral shaft tractures. But, various morbidities due to proximity of several important structures, such as rotator cuff and radial nerve, follwed the operation. We reviewed our experience with 23 cases of humeral shaft fractures that were treated by interlocking intramedullary nailing to evaluate the pitfalls and the complications of this technique. Fifteen men and 8 women were followed for average 19.5 months. Twenty one (91.3%) of them had midshaft fractures. According to AO/ASIF classification, type A was most common(60.9%), and followed by type B(26.1%) and type C(13.O%). Eighteen of them had associated injuries - 5 radial nerve palsies, 1 Volkmans ischemic contracture, and 14 had fracture of other sites. Indications for interlocking intramedullary nailing were unsatisfactory reduction after closed reduction, fracture of the ipsilateral upper extremity, segmental fractures, and multiple injuries. The operation was performed average 6.7 days after injury. The final results were evaluated with radiographs for quality of union and with physical examination for functional status of the shoulder. There were four cases of complication associated with increase morbidity. A post operative radial verve palsy, associated with the distal interlocking screw fixation was developed due to inappropriately short nail insertion. And in one case, fracture healing was delayed due to distraction of the fracture gap after nailing. In another case subacromial impingement was developed secondary to protruded nail tip because the length was thought be the common underlying causative factor. Finally there was a case of iatrogenic fracture at the site of distal interlocking screw fixation and it was thought to be a technical problem. The results gave us the conclusion that inappropriate nail length was the common underlying causative factor of the complications. Therefore in the interlocking IM nailing for the humeral shaft fractures, accurate measurment of nail length is one of the most cirtical factor for the good final result.

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Ender Nailing of Humeral Shaft Fractures: DONG HEON KIM, KYU CHUL SHIN, KYEONG SOON KIM, SANG HAK LEE; J Korean Soc Fract 1997;10(3):614-620. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.614

Abstract PDF

Most humeral shaft fractures are treated conservatively. However, in the event of failure of closed reduction, pathologic fractures, multiple fracture, multiple associated injury and severe neurologic disorder, operative treatment may be indicated. The purpose of this article is to evaluate the effectiveness of Ender nailing for the humeral shaft fracture of the patients who have multiple fracture, multiple associated injury and pathologic fractures. Authors treated 56 patients with humeral shaft fractures by flexible intramedu-llary stabilization- Ender nail or Ender nail with Rush pin 47 cases were treated closed method, 9 cases were treated by open method. Period of follow-up was average 16 weeks. Fractures were united by an average 12 weeks(range : 9 to 20 weeks). There were no non-union, infection and malunion. No backing out of nails occured. In conclusion, Ender nailing is effective treatment for the humeral shaft fracture to decrease hospital stay, to permit early range of motion of the shoulder and elbow joint.

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Contributing Factors of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Tae-Soo Park, Joon-Hwan Lee, Tai-Seung Kim, Kwang-Hyun Lee, Ki-Chul Park
Journal of the Korean Fracture Society.2008; 21(4): 292. CrossRef

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A Comparison of the Using of Plate fixation and Ender nailing in Humeral Shaft Fractures: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Eim, Soo Dong Baek; J Korean Soc Fract 1996;9(1):161-169. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.161

Abstract PDF: The humerus is anatomically and physiologically unique bone: firstly, it is a non-weight bearing bone; secondly, it has greatest range of motion; thirdly, while the person is standing, the axis of bone hangs vertically and is influenced by gravity, and conservative methods are usually used in treatment. However. in the cases of closed reduction failure, open fracture, multiple fracture, and old age etc, operative methods may be employed. This decision should be based on the type, location of fracture. the presence of concomittent injuries, the age, and the general condition of the patient. When open reduction and internal fixation is carried out, the periosteum and soft tissue attachment is stripped off and operative time is longer Flexible Ender nailing is a simple procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, and decreases the chance of infection and allows early exercise. Authors carried out fixation in 28 patients and Ender nailing in 24 patients having humeral shaft fractures who were treated at the orthopedic department, Hae Dong hospital from March, 1990 to February, 1994.

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