Cargando…

Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating

Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complication...

Descripción completa

Detalles Bibliográficos
Autores principales: Souleiman, Firas, Theopold, Jan, Henkelmann, Ralf, Osterhoff, Georg, Pastor, Torsten, Gueorguiev, Boyko, Fakler, Johannes, Hepp, Pierre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864720/
https://www.ncbi.nlm.nih.gov/pubmed/36676737
http://dx.doi.org/10.3390/medicina59010113
_version_ 1784875653871435776
author Souleiman, Firas
Theopold, Jan
Henkelmann, Ralf
Osterhoff, Georg
Pastor, Torsten
Gueorguiev, Boyko
Fakler, Johannes
Hepp, Pierre
author_facet Souleiman, Firas
Theopold, Jan
Henkelmann, Ralf
Osterhoff, Georg
Pastor, Torsten
Gueorguiev, Boyko
Fakler, Johannes
Hepp, Pierre
author_sort Souleiman, Firas
collection PubMed
description Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant–Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23–76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12–97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.
format Online
Article
Text
id pubmed-9864720
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-98647202023-01-22 Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating Souleiman, Firas Theopold, Jan Henkelmann, Ralf Osterhoff, Georg Pastor, Torsten Gueorguiev, Boyko Fakler, Johannes Hepp, Pierre Medicina (Kaunas) Article Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant–Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23–76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12–97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome. MDPI 2023-01-05 /pmc/articles/PMC9864720/ /pubmed/36676737 http://dx.doi.org/10.3390/medicina59010113 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Souleiman, Firas
Theopold, Jan
Henkelmann, Ralf
Osterhoff, Georg
Pastor, Torsten
Gueorguiev, Boyko
Fakler, Johannes
Hepp, Pierre
Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title_full Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title_fullStr Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title_full_unstemmed Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title_short Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating
title_sort combined humeral head and shaft fractures: outcome following intramedullary nailing and plating
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864720/
https://www.ncbi.nlm.nih.gov/pubmed/36676737
http://dx.doi.org/10.3390/medicina59010113
work_keys_str_mv AT souleimanfiras combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT theopoldjan combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT henkelmannralf combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT osterhoffgeorg combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT pastortorsten combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT gueorguievboyko combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT faklerjohannes combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating
AT hepppierre combinedhumeralheadandshaftfracturesoutcomefollowingintramedullarynailingandplating