Clinical Experience Humerus Shaft Fractures

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For more than a decade, we have analyzed more than 100 of humeral fractures with functional braces. The Orthopaedic implants India analysis department has reported detailed results, which have been stated below. 

Before we proceed, we would like to confirm that all orthopedic implants patient’s clinical and radiographic data were recorded and analyzed in an automated data base. The functional braces in the patients were usually applied after an initial period of stabilization. This stabilization was achieved either in long arm casts, sugar-tong splints (These splints are used to stabilize fractures of forearm and wrist by preventing any form of forearm rotation and wrist motion) or Velpeau dressings (Velpeau is a wedge-shaped space with its bottom toward the perineum) for a period that rarely crossed 14 days time period. 

In the first batch of 240 humeral diaphyseal fractures patients, 3/4th cases were of closed fractures and remaining were open. In such cases, around 49% of the fractures occurred as a result of fall down injury and approx 20% were from gunshot abrasions. Nineteen percent of the fractures were in the proximal third, 42% in the middle third, and 27% in the distal third. The time duration of the application of the brace from the date of injury ranged from 1 to 97 days with a median value of 11 days and a mode value of 8 and 13 days. Further, approx 10% of the patients had a condition of radial nerve that controls the movement of hand and arm. 

In the remaining 1/4th cases of closed fractures, there were few cases in which nerve discrepancy was recognized right away after the initial insult and it was observed that in such cases recovery of nerve function occurred spontaneously. 

The ortho surgical implants doctors that conducted the treatment were not in a position to state whether recovery was truly complete since some patients after discharge did not return, even after long-term follow up. Out of the remaining approx, 5% of the patients had associated arterial injuries, which required further surgical treatment. Remaining patients of closed fractures required skin maceration under the sleeve treatment. 

The overall average time for brace removal in patients was 10 weeks. Result was also analyzed after removal of the sleeves and was found that almost 55% of the patients had normal muscle motion and only one patient had regained half of the motion of the shoulder. Also, in analysis of elbow motion, it was found that 70% of the patients had regained the elbow motion (both flexion and extension kind).

Our orthopaedic implants and instruments team further analyzed the report on angular deformities. The study mentioned that angular deformities were frequently encountered, but in most cases, these were of a satisfactory degree. To help you understand better, we created a percentage based analysis and found that almost 80% of the patients had less than 5° of angular deformity and only five patients had more than 10° while rest varied. Minor angular deformities were analyzed by trauma implants specialists and the report suggested that the most common form of the deformity was Varus deformity. 

Loss of the normal small degree of cubitus valgus does not seem to have any kind of functional or cosmetic implications on the body of patients. It should also be kept in mind that major deviations from the normal are obviously unacceptable and should be corrected immediately.

The degree of angular deformity is greater in fractures in the distal third, which requires close observation of the patient and the prompt institution of exercises before and after the collar and cuff have been removed. Experience has indicated that the dependency of the extremity before and after removal of the collar-and-cuff sling assists in the spontaneous resolution of most deformities. Undesirable deformities must be corrected by gentle manipulation and may require the abandonment of the functional brace treatment.

Associated radial nerve palsy is common in fractures of the humeral shaft and it has been long term believe of orthopedic surgical instruments specialists that these can be corrected completely without much mark or impact. “Although this is true for closed fractures, it is obviously not the case in many instances of open fractures, particularly in those resulting from stabbing or gunshot impact”, states orthopedic implant company head analyst. 

Paralysis that develops after regular attempts made to improve the alignment of the fracture may be taken more seriously because of the chances of disconnection of the nerve at the time of alignment or its infringement between the fragments.

Failure to recognize signs of recovery by orthopedic implants doctor within the first few weeks requires further analysis using electrical and other diagnostic tests. This is generally done to determine the type of nerve damage and accordingly, subsequent surgical interference is then planned.

Visiting Spine Implants doctors at our orthopedic implant company states that painful blockage of motion of the shoulder is common in humeral shaft fractures that are treated with casts or other stabilizing devices. Generally, this complication is more commonly found in aged people who do not perform any physiotherapy or carry regular exercises of extremity during the early days of the detection of the disability. 

To clarify, we have analyzed our experience with 80+ comminuted extra-articular distal third fractures of the humerus that were treated with functional braces. As opposed to the reports based on other methods of treatment, our analysis of the above mentioned cases of comminuted fractures was quite gratifying. Though in these cases of treatment with functional braces, there was an overall nonunion rate of 4%, it must also be recognized that in this group 17% of the fractures were open and the overall occurrence of nerve palsy was 18.5%. Of these 80 patients with complete x-ray follow-up, Varus was by far again the most common angular irregularity. 

Despite the occurrence of Varus and other angular deformities in the distal fracture, the final range of motion was normal in over half of the patients, and over 4/5th of the patients had only slight or no limitations. The reported stated range of motion at the end of the examination. 

The orthopedic surgical instruments report stated a range of motion at the time of the last examination, if there were only multiple organ system involvement in fractures and the patient requires constant bed recumbence. Otherwise, there were many cases when patients with the occurrence of more than one fracture, but without injuries to other organ systems, can be fruitfully treated by nonsurgical functional means which involved a combination of ipsilateral fracture of the tibia and femur also called floating knee fractures and humerus fractures of femoral and humeral fracture.  Orthopedic implants India doctor generally treat the femoral fracture by intramedullary fixation and the humeral fracture by a functional sleeve. In the humeral fracture case, the fractured upper extremity is stabilized in a Peplau dressing (articulated and communicated dressing) and followed by the few days of relative rest which the distressed patient requires.

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