Abstract
Fracture of humeral shaft (HSF) is of common occurrence. Historically from days of Hippocrates, this fracture has been treated nonoperatively. The three major advances in medicine, anaesthesia (1846), antisepsis (1865), and X-rays (1895), led to the treatment of such fractures by open reduction and internal fixation. Von Langenbeck in 1855 treated a nonunion of the humerus with screws connected by a devise designed for this purpose. In the next 100 years, a sea of change was observed in the science of osteosynthesis. Dynamic compression plates (DCP) came into use since the 1960s, and Muller introduced the interfragmentary compression of fractures. In the early part of the twenty-first century, locked plate technology was introduced which enabled surgeons to manage fractures with indirect reduction techniques while providing stable fracture fixation.
Majority of diaphyseal humeral fractures can be treated successfully by nonoperative methods like bracing, but operative intervention is indicated in several situations. There are absolute and relative indications. Open fractures takes precedence as absolute indication for operative fixation. Patients with Grade I and II open fractures may benefit from immediate internal fixation. Application of novel MIPO technique (minimally invasive plate osteosynthesis) further improved the outcome of surgical fixation having lower complication as compared to conventional open plating. In certain fractures of mid-shaft of humerus, intramedullary nailing (IMN) is preferred over plate osteosynthesis because it reduces blood loss and postoperative infections. Anterior MIPO technique is used extensively for distal diaphyseal humerus fractures. Stable fixation, preventing iatrogenic injuries to adjacent joints, and protection of the radial nerve are of utmost importance to maximize functional outcome in HSFs.
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References
Ekholm R, Adami J, Tidermark J, et al. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006;88:1469–73.
Kim SH, Szabo RM, Marder RA. Epidemiology of humerus fractures in the United States: nationwide emergency department sample. Arthritis Care Res. 2012;64:407–14.
Gregory PR. Fractures of the humeral shaft. In: Bucholz RW, Heckman JD, editors. Rock wood and Green’s fractures in adults. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 973–96.
Fears RL, Gleis GE, Seligson D. Diagnosis and treatment of complications: fractures of the diaphyseal humerus. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, editors. Skeletal Trauma. 2nd ed. Toronto: WB Saunders; 1998. p. 567–78.
Dabezeis EJ, Banta CJ, Murphy CP, Ambrosia RD. Plate fixation of the humeral shaft for acute fractures with and without radial nerve injuries. J Orthop Trauma. 1992;6(1):10–3.
Wright TW, Miller GJ. Reconstruction of the humerus with an intramedullary fibular graft. J Bone Joint Surg Br. 1993;75(5):804–7.
Habernek H, Schrmid Z, Orthner E. Initial experiences with humerus interlocking nail. Unfall Chirurgie. 1992;18(4):233–7.
Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M. Humeral shaft fractures: a review. J Shoulder Elb Surg. 2011;20(5):833–44.
Breasted JH. The Edwin smith surgical papyrus: published in facsimile and hieroglyphic transliteration with translation and commentary in two volumes. Chicago, IL: The University of Chicago Press; 1930.
Brorson S. Management of Fractures of the Humerus in ancient Egypt, Greece, and Rome- a historical review. Clin Orthop Relat Res. 2009;467:1907–14.
Hippocrates. On Fractures. Withington ET, trans. Cambridge, MA: Harvard University Press; 1984.
Milne JS. The apparatus used by the Greeks and romans in the setting of fractures and the reduction of dislocations (part I). Interstate Med J. 1909;16:48–60.
Thorat NS, Raut SY, Kedar NM. Orthopaedics in Ayurveda – bhagna chikitsa: a review article. Int Ayurvedic Med J. 2017;5(6):2164–71.
Afshar A, Steensma DP, Kyle RA. Antonius Mathijsen and plaster casts. May Clinic proceedings. 2017;92(5):e83.
Sarmiento A, Kinman P, Galvin E, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977;59:596–601.
Rutgers M, Ring D. Treatment of diaphyseal fractures of the humerus using a functional brace. J Orthop Trauma. 2006;20:597–601.
Bartonicek J. Early history of operative treatment of fractures. Arch Orthop Trauma Surg. 2010;130:1385–96.
Heine C. Ueber operative Behandlung der Pseudarthrosen. Langebecks Archiv (Arch Klin Chir). 1878;22:472–95.
Hansmann H. Eine neue Methode der Fixierung der Fragmente bei complicierten Fracturen. Verh Dtsch Ges Chir 1886;15:134–137.
Senn N. A new method of direct fixation of the fragments in compound and ununited fractures. Ann Surg. 1893;18:125–51.
Milne R. Remarks. Clin JB Murphy. 1913;2:229–34.
Putti V. Un nuovo metodo di osteosintesis. Clin Chir. 1914;22:1021–4.
Parham FW. Circular constriction in the treatment of fractures of the long bones. Surg Gyn Obst. 1916;23:541–4.
Lane WA. The operative treatment of fractures. 2nd ed. London: Medical Publishing Co; 1914.
Lambotte A. Chirurgie opératoire des fractures. Paris: Masson; 1913.
Hey Groves EW. On modern methods of treating fractures. New York: Wood and Co; 1916.
Sherman WO. Vanadium steel bone plates and screws. Surg Gyn Obst. 1912;14:629–34.
Eggers GWN. Internal contact splint. J Bone Joint Surg Am. 1948;30:40–52.
Danis R. Théorie et pratique de l’ostéosynthèse. Paris: Masson; 1949.
Bagby GW, Janes JM. The effect of compression on the rate of fracture healing using a special plate. Am J Surg. 1958;95:761–71.
Müller ME, Allgöwer M, Willenegger H. Compression fixation with plates. In: Technique of internal fixation of fractures. Berlin: Springer; 1995. p. 47–51
Schenk R, Willenegger H. Morphological findings in primary fracture healing. In: Krompecher S, Kerner E, editors. Callus formation symposium on the biology of fracture healing. Akadémiai Kiadó: Budapest; 1967. p. 75–86.
Uhthoff HK, Poitras P, Backman DS. Internal plate fixation of fractures: short history and recent developments. J Orthop Sci. 2006;11:118–26.
Perren SM, Klaue K, Pohler O, Predieri M, Steinemann S, Gautier E. The limited contact dynamic compression plate (LC-DCP). Arch Orthop Trauma Surg. 1990;109:304–10.
Perren SM, Buchanan JS. Basic concepts relevant to the design and development of the point contact fixator (PC-fix). Injury. 1995;26:SB1–SB4.
Perren SM. Evolution on the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002;84:1093–110.
Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech. 2007;22:1049–62.
Frigg R. Development of the locking compression plate. Injury. 2003;34:SB6–SB10.
Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34:SB31–SB42.
Kocher T. Chirurgische Operationslehre. Jena: Fisher; 1907.
Thompson JE. Anatomical methods of approach in operations on the long bones of the extremities. Ann Surg. 1918;68:309–29.
Huttunen TT, Kannus P, Lepola V, et al. Surgical treatment of humeral-shaft fractures: a register-based study in Finland between 1987 and 2009. Injury. 2012;43:1704–8.
Schoch BS, Padegimas EM, Maltenfor TM, Krieg J, Namderi S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18:259–63.
Swiontkowski MF, Agel J, McAndrew MP, Burgess AR, Mac Kenzie EJ. Outcome validation of the AO/OTA fracture classification system. J Orthop Trauma. 2000;14(8):534–41.
Pignatoaro GS, Junqueira AE, Matsunaga FT, Matsumoto MH, Belloti JC, Tamawoki MJS. Evaluation of the reproducibility of the AO/ASIF classification for humeral shaft fractures. Rev Braz Orthop. 2015;50(4):378–82.
Yigit S. What should be the timing of surgical treatment of humeral shaft fractures? Medicine (Baltimore). (2020);99 (17):e19858.
Stedtfeld HW, Biber R. Proximal third humeral shaft fractures – a fracture entity not fully characterized by conventional AO classification. Injury. 2014;45(Suppl 1):S54–9.
Court-Brown CM, McQueen MM. Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma. 2008;64:1517–21.
Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury. 2005;36(1):75–80.
Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of humeral shaft fractures-a meta-analysis. Acta Orthop. 2006;77(2):279–84.
Moon JG, Kwon HN, Biraris S, Shon WY. Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopaedics. 2014;37(3):e237–43.
Lau TW, Leung F, Chan CF, Chow SP. Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture. Int Orthop. 2007;31(5):657–64.
Tan JCH, Kagda FHY, Murphy D, Thambiah JS, Khong KS. Minimally invasive helical plating for shaft of humerus fractures: technique and outcome. Open Orthop J. 2012;6:184–8.
Krishna KR, Sridhar I, Ghista DN. Analysis of the helical plate for bone fracture fixation. Injury. 2008;39(12):1421–36.
Wang Q, Hu J, Guan J, Chen Y, Wang L. 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 Res. 2018;13(203):1–7.
Toivanen JA, Nieminen J, Laine HJ, et al. Functional treatment of closed humeral shaft fractures. Int Orthop. 2005;29(1):10–3.
Li Y, Tian Q, Leng K, Meng G. Comparison of the posterior and anterolateral surgical approaches in the treatment of humeral mid-shaft fractures: a retrospective study. Med Sci Monit. 2020;26(e924400):1–10.
Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. 2011;6:CD005959.
Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elb Surg. 2013;22(3):387–95.
Wen H, Zhu S, Li C, Chen Z, Yang H, Xu Y. Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures: An update meta-analysis. Medicine (Baltimore). 2019;98(46):e17952.
Shetty MS, Ajith Kumar M, Sujay KT, Kini AR, Kanthi KG. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures. Indian J Orthop. 2011;45(6):520–6.
Singh AK, Narsaria N, Seth RR, Garg S. Plate osteosynthesis of fractures of the shaft of the humerus: comparison of limited contact dynamic compression plates and locking compression plates. J Orthop Traumatol. 2014;15:117–22.
Shen L, Qin H, An Z, Zeng B, Yang F. Internal fixation of humeral shaft fractures using minimally invasive plating: comparative study of two implants. Eur J Orthop Surg Traumatol. 2012;5:1–8.
Mahajan AS, Kim YJ, Kim JH, D’sa P, Lakhani A, Ok HS. Is anterior bridge plating for mid-shaft humeral fractures a suitable option for patients predominantly involved in overhead activities? A functional outcome study in athletes and manual laborers. Clin Orthop Surg. 2016;8:358–66.
Catagni MA, Lovisetti L, Guerreschi F, Camagni M, Albisetti W, Compangnoni P, Combi A. The external fixation in the treatment of humeral diaphyseal fractures: outcomes of 84 cases. Injury. 2010;41(11):1107–11.
Hohmann E, Glatt V, Tetsworth K. 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 Elb Surg. 2016;25:1634–42.
An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop. 2010;34:131–5.
Shin SJ, Sohn HS, Do NH. Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize complications. J Orthop Trauma. 2012;26:585–9.
McCormack RG, Brien D, Buckley RE, et al. Fixation of fractures of the shaft of the humerus by 523 dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br 2000;82(3):336–9.
Shao YC, Harwood P, Grotz M, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus – a systematic review. J Bone Joint Surg Br. 2005;87:1647–52.
Chang H, Yao ZL, Hou YL, Cao Y, Guo XH, Li GJ, Yu B. Lateral subcutaneous locking compression plate and small incision reduction for distal-third diaphyseal humerus fractures. Orthop Surg. 2018;10(3):218–26.
Jain D, Goel GS, Garg R, Mahindra P, Yamin M, Selhi HS. Outcome of anatomic locking plate in extraarticular distal humeral shaft fractures. Indian J Orthop. 2017;51(1):86–92.
Ali N, Ahmad Mir N, Ahmad Dar T, Nawaz Rather M, et al. Outcome of extra-articular distal Humerus fractures fixed by single column extra-articular distal Humerus locking compression plate using triceps sparing Postero-lateral approach. Bulletin of Emergency and Trauma. 2018;6(4):306–12.
Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006;88(11):2343–7.
Bhashyam A, Ochen Y, van der Vliet QMJ, Leenen LPH, et al Association of patient-reported outcomes with clinical outcomes after distal humerus fracture treatment. JAAOS Glob Res Rev. 2020;4(2):e19. 00122, 1–8.
Ma J, Xing D, Ma X, et al. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis. PLoS One. 2013;8:e82075.
Zhao JG, Wang J, Wang C, Kan SL. Intramedullary nail versus plate fixation for humeral shaft fractures: a systematic review of overlapping meta-analyses. Medicine (Baltimore). 2015;94(11):e599.
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Debnath, U.K. (2023). Implantology of Fractures of the Shaft of Humerus. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_68
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