Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury, a simutaneous injury is rare. We present such a case combined with head injury which took precedence over the skeletal injuries. The postoperative rehabilitation was slowed down by the head injury. This case report makes us aware of some problems when managing the patient with this rare injury and helps us understand the management options better. Also the need for proper follow-up and rehabilitation is emphasized.
Adult ; Craniocerebral Trauma ; complications ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Shoulder Dislocation ; complications

Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate. The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal. On the second postoperative day, following the suction drain removal and dressing, patient developed immediate radial nerve palsy along with wrist drop. We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure.
Adult ; Female ; Humans ; Humeral Fractures ; surgery ; Postoperative Complications ; Radial Neuropathy ; etiology

OBJECTIVE: To explore clinical effect of lateral locking compression plate combined with medial buttress plate in treating osteoporotic comminuted fractures of proximal humerus. METHODS: From May 2017 to December 2021, 12 patients with osteoporotic comminution of proximal humerus were treated by lateral locking compression plates combined with medial buttress plates, including 5 males and 7 females, aged from 55 to 78 years old, bone mineral density(BMD) less than -2.5 g/cm3, the time from injury to operation was from 2 to 6 days. According to Neer classification, 7 patients were type Ⅲ, 4 patients were type Ⅳ and 1 patient was type Ⅵ. Postoperative complications, fracture healing and internal fixation were observed and Constant-Murley score of shoulder joint was used to evaluate clinical effects at 6 months after operation. RESULTS: Postoperative wound healed well at stage I. All patients were followed up from 6 to 18 months. Humeral head collapse and necrosis occurred in 1 patient and humeral head varus in 1 patient. No impact of shoulder joint, internal fixation loosening occurred. Constant-Murley score at 6 months ranged from 45 to 90 points, and 6 patients got excellent result, 3 good, and 3 poor. CONCLUSION Locking compression plate combined with medial buttress plate could effectively reconstruct medial humeral column support and enhance fracture stability, and receive satisfactory clinical results. However, no control group was established in this study, and function of shoulder joint has not been evaluated many times after operation, so it cannot dynamically reflect changes of shoulder joint function.
Aged ; Female ; Humans ; Male ; Middle Aged ; Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fractures, Comminuted/surgery* ; Humeral Fractures/complications* ; Humeral Head ; Humerus ; Shoulder Fractures/surgery* ; Treatment Outcome ; Osteoporotic Fractures/surgery*

INTRODUCTIONThe failure of a humeral fracture to unite after surgical treatment may be due to many factors. When there are additional complications of infection, treatment by conventional methods of internal fixation becomes very difficult.

MATERIALS AND METHODSWe treated 8 infected non-union of diaphyseal fracture of the humerus by the Orthofix external fixator. All had previous surgical treatment. Non-union followed plating in 6 cases and in 2 cases after the external fixator. All patients had pain, at least one sinus discharging pus and severe functional impairment of the affected arm. There were 6 men and 2 women with a mean age 40.6 years.

RESULTSBone union was achieved in all cases. The mean time to union was 4.5 months (range, 2 to 8). Patients expressed high levels of satisfaction with the outcome, despite relatively modest improvement in pain and function, mainly because of long standing infection and intractable non-union. There were no major pin tract problems requiring the removal of the Schanz screws. Radial nerve palsy developed in 1 patient who recovered spontaneously. No patient required an additional bone grafting procedure.

CONCLUSIONThe use of the Orthofix external fixator without bone grafting was successful in the treatment of infected non-union of the humeral shaft. It shortened the duration of hospitalisation and immobilisation with moderate functional recovery.

Adult ; Bacterial Infections ; complications ; External Fixators ; Female ; Fractures, Ununited ; complications ; surgery ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Middle Aged ; Treatment Failure ; Young Adult

Adolescent ; Adult ; Female ; Humans ; Humeral Fractures ; complications ; Humerus ; surgery ; Joint Deformities, Acquired ; surgery ; Male ; Orthopedic Fixation Devices ; Osteotomy ; methods

OBJECTIVETo discuss the treatment methods of humeral supracondylar fracture in children with neurovascular complications.

METHODSNinety-six children (59 males, 37 females) with humeral supracondylar fractures were treated by surgery from February 2002 to November 2007, with the mean age of 6.4 years old (ranged from 4 to 16 years). Seventeen symptoms of nerve damage occurred in 16 cases, including radial nerve injury in 5 cases,median nerve injury in 7 cases,of which 1 cases with ulnar nerve injury, ulnar nerve injury in 5 cases; 13 patients had symptoms of vascular injury such as pulse weakness and hands coldness. The patients accompanied by nerve, blood vessel injury symptoms were all treated with open reduction and internal fixation.

RESULTSEighty-five patients were followed up with an average duration of 11 months(ranged from 6 to 18 months). Seventy-three patients had incision healing at the first stage and other 12 patients had incision healing at the second stage. All the 85 patients had no complications such as incision infection and functional disturbance of elbow joint. Among 5 patients with radial nerve injury, 3 patients had symptoms disappeared completely at 3 months after operation; one patient underwent exploration lysis at 3 months after operation and the symptoms disappeared at 5 months after operation; another 1 patient with iatrogenic injury of radial nerve had nerve function recovered at 3 months after releasing plaster compression. Among 7 patients with median nerve injury, 6 patients had nerve function recovered completely at 6 months after operation; another 1 patient combined with ulnar nerve injuries had nerve function recovered at 9 months after exploring of nerve at the second stage. Five patients with ulnar nerve injury had nerve function recovered completely at 6 months after operation. Preoperative symptoms of radial artery pulse weakness and cold hand in 13 patients disappeared after fracture reduction.

CONCLUSIONThe ulnar nerve should be explored during the operation at the first stage of supracondylar fracture. Wether the median nerve, radial nerve and blood vessel be explored or not should be decided by preoperative examination results. The preoperative EMG and Doppler ultrasound examination is not a routine examination before surgery.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Peripheral Nerve Injuries ; Vascular System Injuries ; surgery

The outward angulation of elbow with supinated forearm is cubitus varus deformity. This deformity is often seen as sequelae of malunited supracondylar fracture of humerus in paediatric age group of 5e8 years. The deformity is usually non-progressive, but in cases of physeal injury or congenital bony bar formation in the medial condyle of humerus, the deformity is progressive and can be grotesque in appearance. Various types of osteotomies are defined for standard non-progressive cubitus varus deformity, while multiple surgeries are required for progressive deformity until skeletal maturity. In this study we described a novel surgical approach and osteotomy of distal humerus in a 5 years old boy having grotesque progressive cubitus varus deformity, achieving good surgical outcome.
Child, Preschool ; Elbow Joint ; injuries ; Fractures, Malunited ; complications ; Humans ; Humeral Fractures ; complications ; Humerus ; surgery ; Joint Deformities, Acquired ; surgery ; Magnetic Resonance Imaging ; Male ; Osteotomy ; methods

OBJECTIVETo retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.

METHODSFrom October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months.

RESULTSThe time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.

CONCLUSIONSFixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.

Adolescent ; Adult ; Aged ; External Fixators ; Female ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Middle Aged ; Radial Neuropathy ; etiology ; Retrospective Studies

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neurovascular injury due to fracture fragments following this type of fracture is described. Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.
Brachial Artery ; diagnostic imaging ; injuries ; Child ; Humans ; Humeral Fractures ; complications ; diagnostic imaging ; surgery ; Male ; Tomography, X-Ray Computed

Nonunion of the humerus in a severely osteoporotic bone is a likely event especially if the fracture is transverse. The management of such a combination is a challenge. Most of the conventional fixation methods are unlikely to succeed as the bone failure precedes implant failure in osteoporosis. The challenge is further compounded in severe osteoporosis when the cortical thickness is affected more severely. We used a combination of an intramedullary fibula with a locking plate in 5 cases. The results show that it may be a good combination in such situations as the bone strength is augmented and the plate pullout is less likely.
Aged ; Bone Plates ; Female ; Fibula ; transplantation ; Fracture Fixation, Intramedullary ; methods ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications