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Abdulsamad AM, Al Mugren T, Alzahrani MT, Alanbar FT, Althunayan TA, Mahayni A, Alfarag AH, Alotaibi MT, Almuqbil M, Alfarraj AH. Outcomes of the Treatment of Humeral Shaft Fractures by Closed Reduction and Internal Fixation With Multiple Intramedullary Kirschner Wires (K-wires). Cureus 2023; 15:e51009. [PMID: 38143728 PMCID: PMC10748805 DOI: 10.7759/cureus.51009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background Humeral shaft fractures are common orthopedic injuries, and their treatment options vary based on fracture characteristics. One surgical method involves closed reduction and internal fixation (CRIF) with multiple intramedullary (IM) Kirschner wires (K-wires), which remains less explored, especially in adults. This study aims to investigate the outcomes of the treatment of humeral shaft fractures by closed reduction and internal fixation with multiple flexible intramedullary K-wires. Materials and methods We conducted a retrospective study at King Abdulaziz Medical City, Riyadh, Saudi Arabia, focusing on patients with traumatic humeral shaft fractures who underwent flexible intramedullary K-wire fixation. We analyzed nine patient records for demographic information, fracture location, type, mechanism of injury, intra-operative and post-operative factors, and complications. Results Fractures mostly affected the middle third of the humerus (55.6%) and were primarily transverse or oblique (77.8%). Motor vehicle accidents were the leading cause of injury (66.7%). Intra-operative time was 125 minutes on average, with minimal blood loss (78 mL). No participants required intra-operative blood transfusion. Complications following IM K-wire fixation were absent in all cases. Three patients had not yet undergone instrumental removal, and most reported mild or no pain during the final follow-up. All participants achieved a full range of motion for their elbows. All participants achieved complete radiological and clinical union (healing) of their fractures. Conclusion The use of multiple intramedullary K-wires for the treatment of humeral shaft fractures in this study demonstrated positive outcomes with low complication rates. This approach provides an effective option for managing these fractures, particularly in cases where surgical indications favor it.
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Affiliation(s)
- Adham M Abdulsamad
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Turki Al Mugren
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Mohammed T Alzahrani
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Faisal T Alanbar
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Turki A Althunayan
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Abdullah Mahayni
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Abdulrahman H Alfarag
- Department of Surgery, Division of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Mohammad T Alotaibi
- Department of Orthopedic Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Musab Almuqbil
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Ahmed H Alfarraj
- Department of Orthopedic Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
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Evaluation and Management of Pediatric Humeral Shaft Fractures. J Am Acad Orthop Surg 2023; 31:265-273. [PMID: 36729652 DOI: 10.5435/jaaos-d-22-00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023] Open
Abstract
Diaphyseal humerus fractures in the pediatric population have dynamic treatment strategies that depend on injury pattern, mechanism, patient skeletal maturity, and size. Treatment strategies include closed reduction with various immobilization techniques, flexible nails, uniplanar or multiplanar external fixation, or plate osteosynthesis. Accepted parameters for sagittal and coronal alignment vary based on age and potential for remodeling, and the multiplanar motion of the shoulder joint can accommodate for greater variations in alignment than many other long bone fractures. Complications such as radial nerve palsy are possible with both open and closed injuries, and mal/nonunions, although rare, can occur. Overall, treatment should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries.
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ALBERGHINA F, CANAVESE F, ANDREACCHIO A. Humeral shaft fractures in children and adolescents. MINERVA ORTHOPEDICS 2021; 72. [DOI: 10.23736/s2784-8469.20.04040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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Hannonen J, Sassi E, Hyvönen H, Sinikumpu JJ. A Shift From Non-operative Care to Surgical Fixation of Pediatric Humeral Shaft Fractures Even Though Their Severity Has Not Changed. Front Pediatr 2020; 8:580272. [PMID: 33240832 PMCID: PMC7677593 DOI: 10.3389/fped.2020.580272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear. Materials and Methods: All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ~86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases. Results: There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, p = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, p = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk. Conclusions: The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.
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Affiliation(s)
- Juuli Hannonen
- Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Elina Sassi
- Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Hanna Hyvönen
- Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.,Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
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Canavese F, Marengo L, Samba A, Rousset M, Mansour M, Andreacchio A, Dimeglio A. Evaluation of upper extremity function of displaced diaphyseal humeral fractures in children treated by elastic stable intramedullary nailing: preliminary results. J Pediatr Orthop B 2016; 25:399-405. [PMID: 27058818 DOI: 10.1097/bpb.0000000000000318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this study was to retrospectively evaluate the outcome of displaced humeral shaft fractures in children and adolescents treated by elastic stable intramedullary nailing (ESIN) and to evaluate upper extremity function using the Quick-DASH questionnaire. Correction was maintained over time in 14 of 16 patients. All patients were pain free at last follow-up. Shoulder and elbow ranges of motion were comparable with the noninjured side. The mean Quick-DASH score was 1. This study reports good functional outcomes in children with displaced humeral shaft fractures surgically treated with ESIN, even in the presence of residual deformity. ESIN enables stable reduction, good rotational control, and good functional outcome.
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Affiliation(s)
- Federico Canavese
- aDepartment of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand bFaculty of Medicine, University of Montpellier, Montpellier, France cDepartment of Pediatric Orthopedic Surgery, Regina Margherita Children's Hospital, Torino, Italy
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Marengo L, Rousset M, Paonessa M, Vanni S, Dimeglio A, Samba A, Andreacchio A, Canavese F. Displaced humeral shaft fractures in children and adolescents: results and adverse effects in patients treated by elastic stable intramedullary nailing. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:453-9. [PMID: 26988699 DOI: 10.1007/s00590-016-1758-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
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Sié EJ, Kacou AD, Traoré A, Mobiot C, Bamba I, Lambin Y. Closed retrograde multiple intramedullary Kirschner wires fixation for humeral shaft fractures with the limb flexed over an articulated support. J Clin Orthop Trauma 2014; 5:45-9. [PMID: 25983469 PMCID: PMC4009460 DOI: 10.1016/j.jcot.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/13/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the results of multiple closed intramedullary Kirschner wiring via a supracondylar entry point for humeral shaft fractures. PATIENTS AND METHODS The charts of 37 patients with humeral shaft fractures treated with the Hackethal's technique between January 2007 and December 2011 were reviewed retrospectively. The operation was performed with the patient lying in supine (n = 22) or lateral (n = 15) position. The elbow was flexed over an articulated support with the arm kept in a vertical position. Thirty-three patients were available for final evaluation with a mean follow-up delay of 14 (range, 6-24) months. We were concerned about fracture union, range of motion of the shoulder and the elbow, and complications. Final evaluation used the criteria by Qidwai. RESULTS Bone union rate was 94%. Restriction of ranges of motion of the shoulder more than 20° was noticed in two patients due to protruding wires. Three patients developed limitation of elbow extension owing to backing out of the wires. The overall results were excellent (n = 26; 79%), good (n = 4; 12%), and poor (n = 3; 9%). CONCLUSION Closed Hackethal's technique using K-wires gives satisfactory results in terms of bone union and elbow and shoulder function in selected humeral shaft fractures. The articulated support precludes the transolecranon traction.
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Martínez Martína A, Herrera Rodrígueza A, Cuenca Espiérreza J, Pérez Garcíaa J, Herrero Barcosa L, García Esteveb J. Factores predictivos de la pseudoartrosis de húmero en fracturas cerradas diafisarias. Rev Esp Cir Ortop Traumatol (Engl Ed) 2003. [DOI: 10.1016/s1888-4415(03)76066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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