Diaphyseal fractures of the humerus. How to treat conservatively and when needed surgery?

Authors

  • Valeriy Litvishko

DOI:

https://doi.org/10.15674/0030-59872016396-103

Keywords:

diaphyseal fractures, humerus, the rationale of treat¬ment techniques, functional treatment, osteosynthesis

Abstract

According to the Kharkiv interdistrict MSEK (2012) using of in­ternal osteosynthesis results into high incidence of nonunion of the humeral fractures — 24 % 4 months after plating.

Purpose: to justify treatment guidelines of diaphysial humeral fractures using 30-years scientific and practical experience for presenting an improved method of treatment and to present achieved re­sults.

Methods: To evaluate the results of treatment in 73 patients with humeral fractures treated from 2006 to 2014. Functional conservative treatment with orthosis — 39 people, external fixa­tion device (EFD) — 16 (13 after closed reduction, open 3). In 18 patients applied internal osteosynthesis. Clinical material is analyzed since 1984 (104 cases).

Results: main features that in­fluence the choice of treatment method such as the displacement of the bone fragments in the initial radiograph, fracture level, other damage, limiting the mobility of the injured, the condition of the radial nerve are distinguished and characterized. Details of functional treatment of fractures of the humerus with the cast and pin EFD are presented.

Conclusion: in a case monolocal diaphyseal fractures of the humerus one should choose a con­servative functional treatment method — the safest in case of complications, providing fusion of fragments in a short time, well-tolerated by patients and requiring low material costs. For a fixed displacement of fragments greater than the diameter of the bone, and associated lesions, excluding or significantly limiting the vertical position of the patient, it is advisable to use EFD. Open reduction is required for the displacement of bone fragments in the full width, irremovable hanging shoulder posi­tion within 2–5 days. Revision of the radial nerve is indicated with considerable fixation and displacement of bone fragments.

References

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Litvishko V. «The behaviour» of bone fragments during functional treatment of humerus diaphyseal fractures. Orthopaedics, Traumatology and Prosthetics. 1998; (1):98-100.

Litvishko V. Functional treatment of humerus diaphyseal fractures. Summary of thesis for the scientific degree of the candidate of medical sciences; 14.00.22 in specialty 14.01.21 – Traumatology and Orthopedics. Kharkiv, 1999. 20 p.

Popsuishapka O, Litvishko V. The treatment of diaphyseal fracture of the humerus using splint-tissue orthosis. Orthopaedics, Traumatology and Prosthetics. 1998;(3):90-3.

Popsuishapka O. The functional treatment of diaphyseal fractures of bones of extremities (clinical and experimental basis). Thesis for the scientific degree of the doctor of medical sciences; 14.00.22 in specialty 14.01.21 – Traumatology and Orthopedics. Kharkiv, 1991. 273 h.

Popsuishapka O, Litvishko V, Borovik I. The functional treatment of diaphyseal fractures of extremities with use of rod external fixators for elastic and resistant connection of bone fragments. Guidelines. Kiyv, 2014. 46 p.

Sarmiento A, Latta LL. Closed functional treatment of fractures. Berlin; Heidelberg; N. Y.: Springer Verlag, 1981. 687 p.

Issue

Section

DISCUSSIONS, SEARCH, HYPOTHESES

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