Journal of Musculoskeletal Trauma

Early Corrective Osteoclasis for Malunited Pediatric Medial Condylar Fracture of the Humerus: Hong Jun Jung, Ho Youn Park, Yuna Kim; J Korean Fract Soc 2022;35(1):21-25. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.21

Abstract PDF: Fractures of the medial condyle of the distal humerus in children are very rare, and the younger the age, the more difficult it is to diagnose. These fractures include an intra-articular fracture and a Salter–Harris type IV growth plate fracture. Therefore, the prognosis is poor if the fracture is neglected or misdiag-nosed because of the high incidence of complications such as nonunion, angular deformity, or joint contracture. This paper reports a case of a four-year-old child who presented with a malunion of the medial condyle of the humerus with good results after an early corrective osteoclasis.

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Paratricipital Approach for AO/OTA Type C2 Intra-Articular Fracture of Distal Humerus: Chul Hyung Lee, Doo Hun Sun, Deukhee Jung, Chung Han An; J Korean Fract Soc 2019;32(3):128-134. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.128

Abstract PDF: PURPOSE
The aim of this study was to determine the outcomes of fixation of AO/OTA type C2 fractures among intra-articular fractures of the distal humerus using the paratricipital approach (side to side retraction of the triceps).
MATERIALS AND METHODS
From June 2008 to January 2018, 12 patients underwent an open reduction and internal fixation with the paratricipital approach and were followed-up for more than 10 months after surgery. According to the AO/OTA classification, type C2 fractures were chosen among the intraarticular distal humerus fractures. An extended posterior incision was used over the olecranon in the prone position, preserving the insertion site of the triceps brachii muscle. The fracture site was exposed by retracting the muscle side-to side through a dissection of the medial and lateral intermuscular septum of the triceps brachii muscle. The therapeutic results were assessed by the anatomical reduction of the articular surface and integrity of the metaphyseal contour in postoperative simple radiographs, complications, such as neuropathy or non-union, and the Mayo elbow performance score (MEPS) were checked to estimate the functional outcome.
RESULTS
In the postoperative simple radiographs, no case showed more than 1 mm step-off and the disrupted contour of the distal humerus was recovered to normal alignment in most cases. The range of elbow joint motion in the last follow-up was 133.8Â° on average with a mean flexion contracture of 5.0Â°. The clinical results depending on the MEPS were excellent, except for two cases, which were good. Neuropathy of the ulnar nerve was observed in one patient, which was resolved after metal removal.
CONCLUSION
The paratricipital approach is useful technique in AO/OTA type C2 intra-articular distal humerus fractures that provides sufficient exposure of the surgical field, without injury to the triceps brachii muscle and postoperative complications associated with the trans-olecranon approach.

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Capitellar Osteochondral Impacted Fracture of the Humerus in an Adult Female: A Case Report: Jaekwang Yum, Minkyu Seong, Kyungil Kim; J Korean Fract Soc 2018;31(4):154-158. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.154

Abstract PDF: Capitellar osteochondral impaction fractures of the humerus are an uncommon injury and not encompassed by commonly used classification systems, such as that of Bryan and Morrey. Only a few cases of capitellar osteochondral impaction fractures have been reported. We report a case of a 53-year-old female with a capitellar osteochondral impaction fracture. The osteochondral fracture fragment of the capitellum was impacted and there was a step-off on the articular surface. Recovery of congruence in the capitellar articular surface was necessary. Satisfactory clinical and radiological results were obtained through the â€˜lever armâ€™ reduction of the fracture fragment with a small osteotome and fixation with â€˜raftâ€™ K-wire.

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Conservative Treatment of Proximal Humeral Fracture: Hwansub Hyun, Jonghyun Ahn, Sang Jin Shin; J Korean Fract Soc 2018;31(1):29-35. Published online January 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.1.29

Abstract PDF

A proximal humeral fracture is an osteoporotic fracture that often occurs in elderly women. Approximately 80% of all proximal humeral fractures are non-displaced fractures, which can be treated with conservative treatment to achieve stable union. The treatment plan for fractures involving displaced and comminuted fractures is controversial. Malunion, avascular necrosis of the humeral head, and shoulder stiffness due to conservative treatment can occur but the functional deterioration is low and the patient satisfaction is high. The indications for the conservative management of proximal humeral fractures include a non-displaced fracture and a 2-part fracture, low-functional demanded 3-part fracture, and operative-limited 4-part fracture. Recently, the surgical indications have expanded as technological advances in surgical fixation methods and functional needs of elderly patients are increasing. Current treatment policy decisions tend to be determined by the personal preference and expert opinion rather than by evidence-based decision-making.

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The Effect of Postoperative Korean Traditional Medicine for the of Proximal Humeral Fracture: A Case Report
Hyun Il Go, Hangyul Choi, Jieun Hong, Nam geun Cho
Journal of Acupuncture Research.2019; 36(1): 50. CrossRef

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Minimal Invasive Plate Osteosynthesis versus Conventional Open Plating in Simple Humeral Shaft Fracture (AO Type A, B1, B2): Boseon Kim, GwangChul Lee, Hyunwoong Jang; J Korean Fract Soc 2017;30(3):124-130. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.124

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the efficacy of minimally invasive plate osteosynthesis (MIPO) by comparing the results between open plating and MIPO conducted by simple humeral shaft fractures.
MATERIALS AND METHODS
From September 2010 to February 2015, we evaluated humeral shaft fractures that 26 cases underwent MIPO and 41 cases underwent open plate fixation (OPEN). Operation time, amount of blood loss, and radiative exposure time were examined. Radiographically, bone union time and angulation were compared. At last, UCLA shoulder score and MEPI were used to compare the clinical results of shoulder and elbow and complications were examined.
RESULTS
The average operation time 82Â±23 minutes in MIPO, 119Â±20 minutes in OPEN (p=0.007) and amount of bleeding 238Â±67 ml in MIPO, 303Â±48 ml in OPEN (p=0.003), radiation exposure time 201Â±85 seconds in MIPO, 20Â±5 seconds in OPEN (p=0.000) were statistically significant. Bone union time and angulations, clinical results were not statistically significant. In Complication, iatrogenic radial nerve paralysis occurred 2 cases, nonunion occurred 1 case in MIPO. Nonunion and soft tissue infection occurred 2 cases each in OPEN.
CONCLUSION
MIPO in simple humeral shaft fractures gave us radiologically and clinically satisfactory results, and may be useful by understanding the anatomical knowledge and using appropriate implants and skills.

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Outcomes of Arthroscopic Assisted Reduction and Percutaneous Fixation for Tongue-Type Sanders Type II Calcaneal Fractures
Jae Woo Park, Chul Hyun Park
Journal of Korean Foot and Ankle Society.2017; 21(4): 144. CrossRef

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Posterior Dual Plating for Distal Shaft Fractures of the Humerus: Chul Hyun Cho, Kwang Yeung Jeong, Beom Soo Kim; J Korean Fract Soc 2017;30(3):117-123. Published online July 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.3.117

Abstract PDF: PURPOSE
To evaluate the results and efficacy of posterior dual plating for distal shaft fractures of the humerus.
MATERIALS AND METHODS
We retrospectively analyzed 12 patients, who underwent open reduction and internal fixation using posterior dual plating for distal shaft fractures of the humerus, between July 2007 and July 2015, with at least 6 months of follow-up. After locating the radial nerve without dissection via posterior triceps splitting, the fracture was stabilized using a short 3.5 mm locking compression plate. Then additional fixation, using a long 3.5 mm locking compression plate, was performed. The clinical outcomes were assessed in accordance with the Mayo Elbow Performance Index (MEPI) scoring system, and the radiological outcomes were assessed using serial plain radiographs.
RESULTS
Eleven patients (91.7%) had bony union, and the mean union period was 13.9 weeks. In one patient, delayed union was treated by autogenous iliac bone graft at 8 months after surgery, which resulted in bony union. The mean MEPI score was 95.8, and the clinical outcomes were excellent in 9 patients and good in 3 patients. Postoperative complications included 1 elbow stiffness by heterotopic ossification and 1 temporary radial nerve palsy. One patient with temporary radial nerve palsy was completely recovered within the first 4 days after surgery.
CONCLUSION
Posterior dual plating for distal shaft fractures of the humerus revealed satisfactory clinical and radiological outcomes. It can be a useful alternative to provide stable fixation without the need for a dissection of the radial nerve.

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Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report: Ki Won Lee, Joo Yul Bae, Suk Kyu Lee; J Korean Fract Soc 2017;30(2):83-88. Published online April 30, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.2.83

Abstract PDF: High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.

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Functional Recovery of the Shoulder after Correcting Malrotation of the Distal Humerus: A Case Report: Hyunseong Yoo, Jaehui Han, Youngsoo Byun, Daegeun Jeong, Dongju Shin; J Korean Fract Soc 2016;29(1):73-78. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.73

Abstract PDF: Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.

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Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports: Sam Guk Park; J Korean Fract Soc 2016;29(1):61-67. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.61

Abstract PDF

Some proximal humeral fractures in elderly patients are accompanied by medial metaphyseal comminution and quality of the bone is so poor that head preserving osteosynthesis seems to be amenable. In cases of medial metaphyseal comminution, lateral locking compression plate (LCP) fixation also has a tendency to become a matter of screw cut out or loss of fixation. The author reports on successful treatment of two osteoporotic proximal humeral fractures combined with medial meta-physeal comminution, with application of additional direct medial supporting plate fixation. Medial plate fixations were added when the fractures were still unstable after the conventional lateral LCP fixation and anterior circumflex humeral arteries had been ruptured before. The fixations were stable enough to start exercise immediately after surgery. The inclinations of the humeral neck were not changed until the last follow-up and clinical results were satisfactory without humeral head osteonecrosis which was a concern.

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Dual-Plate Fixation for Proximal Humerus Fractures With Unstable Medial Column in Patients With Osteoporosis
Hyun-Gyu Seok, Sam-Guk Park
Journal of Orthopaedic Trauma.2023; 37(10): e387. CrossRef
The plate fixation strategy of complex proximal humeral fractures
Qi Sun, Xiaoming Wu, Lei Wang, Ming Cai
International Orthopaedics.2020; 44(9): 1785. CrossRef
Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support
Yu He, Yaoshen Zhang, Yan Wang, Dongsheng Zhou, Fu Wang
Journal of Orthopaedic Surgery and Research.2017;[Epub] CrossRef

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Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report: Hyung Lae Cho, Hyoung Min Kim, Ki Bong Park, Tae Hyun Wang, Dong Hyun Lee; J Korean Fract Soc 2016;29(1):50-54. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.50

Abstract PDF: Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

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Cannulated Screw and Wire Fixation with Predrilling for Olecranon Osteotomy in Intra-articular Comminuted Distal Humerus Fractures: Soo Hong Han, Ho Jae Lee, Woo Hyun Kim, Yong Gil Jo, Won Tae Song; J Korean Fract Soc 2015;28(2):118-124. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.118

Abstract PDF: PURPOSE
The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus.
MATERIALS AND METHODS
This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated.
RESULTS
All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem.
CONCLUSION
Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra-articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.

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T-Condylar Fracture of Distal Humerus in a Child: A Case Report: Young Ryeol Pae, Sang Soo Kang, Hyeong Min Kim, Min Jeong; J Korean Fract Soc 2014;27(3):232-236. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.232

Abstract PDF: T-condylar fracture is a type of distal humerus fracture. T-condylar fracture in children is rare, with reported incidence of less than 1% of T-condylar fractures. The mean reported age of T-condylar fracture in children is 11. Cases in children under 5 years-old are extremely rare. Herein, we report on a T-condylar fracture of the distal humerus in a 5-year-old boy. This patient was treated with open reduction and K-wire fixation through the posterolateral approach. The result of treatment was satisfactory; therefore, we report this case.

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Associated Factors of Radial Nerve Palsy Combined with Humerus Shaft Fracture: Si Wuk Lee, Chul Hyun Cho, Ki Choer Bae; J Korean Fract Soc 2014;27(3):185-190. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.185

Abstract PDF

PURPOSE
The purpose of this study was to analyze associated factors of primary radial nerve palsy and to evaluate clinical outcome for its treatment in patients with humerus shaft fracture.
MATERIALS AND METHODS
We divided two groups of patients with (17 patients) and without (116 patients) primary radial nerve palsy and analyzed correlation between radial nerve injury and various parameters, including age, sex, cause of injury, AO classification, fracture type, fracture location, and presence of open fracture. We also evaluated configuration of nerve injury, presence of recovery, and recovery time.
RESULTS
The overall prevalence of primary radial nerve palsy after humerus shaft fracture was 12.8% (17 palsies in 133 fractures). Younger age, AO type B, and distal 1/3 fractures showed significantly higher correlation with radial nerve palsy. No significant correlation was observed between radial nerve palsy and other parameters, including sex, cause of injury, fracture type, and presence of open fracture. Thirteen patients (76.5%) underwent early nerve exploration with internal fixation. Intraoperatively, all patients had continuity of radial nerve except one patient with segmental loss. At the final follow-up, 16 patients (94.1%) with radial nerve palsy had made a complete recovery. The mean time to complete recovery was 6.7 months.
CONCLUSION
Primary radial nerve palsy after humerus shaft fracture was more common in young age, AO type B, distal 1/3 fractures. Early surgical exploration can be recommended to confirm the condition of the radial nerve if the fracture should be fixed.

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Treatment of Radial Nerve Palsy Associated with Humeral Shaft Fracture
Soo-Hong Han, Jin-Woo Cho, Han-Seung Ryu
Archives of Hand and Microsurgery.2020; 25(1): 60. CrossRef

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Isolated Avulsion Fracture of the Lesser Tuberosity of the Humerus: A Case Report: Tae Ho Kim, Ki Do Hong, Sung Sik Ha, Jae Chun Sim, Min Chul Sung; J Korean Fract Soc 2014;27(1):72-76. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.72

Abstract PDF

Isolated avulsion of the lesser tuberosity of the humerus is a rare injury. The mechanism of injury is the avulsion of the lesser tuberosity from forced contractions of the subscapularis muscle when the arm is forced into an externally rotated position on shoulder abduction. Authors report a case for isolated avulsion of the lesser tuberosity of the humerus which was treated with open reduction and transosseous suture fixation, as well as a view of the literature.

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What are the patient-reported outcomes, functional limitations, and complications after lesser tuberosity fractures? a systematic review of 172 patients
Reinier W.A. Spek, Bram J.A. Schoolmeesters, Chantal den Haan, Ruurd L. Jaarsma, Job N. Doornberg, Michel P.J. van den Bekerom
JSES International.2021; 5(4): 754. CrossRef

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Results of Treatment for Medial Condyle Fracture of the Distal Humerus in Children: Jeong Han Kang, Seung Hyeon Yang, Kuk Pil Lim, Hui Taek Kim; J Korean Fract Soc 2013;26(4):261-267. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.261

Abstract PDF: PURPOSE
We evaluated outcomes of treatment in medial condyle fracture of the distal humerus in children.
MATERIALS AND METHODS
Seven patients (4 females, 3 males) who were treated at the Pusan National University Hospital and followed-up until skeletal maturity after treatment were included. The average age at the time of fracture was 4.6 years (range, 2 to 10 years). Treatment was performed from 1 day to 6 months after the fracture: 4 patients underwent a surgical treatment for 17 days, 2 months, 2 months and 6 months after fracture, respectively. All fractures were Milch type 1. Five patients had Kilfoyle type 3, and two patients had type 2 fractures. Final outcomes were evaluated by the Mayo elbow performance score and carrying angle.
RESULTS
There were 3 excellent, 3 good and 1 fair result at the final follow-up. There was no elbow pain in any of the patients. One of the four patients who underwent a late surgical treatment received corrective osteotomy due to cubitus varus. All four patients had a limitation of elbow motion. The other three patients who had accurate diagnosis and treatment had a full range of motion.
CONCLUSION
Diagnosis of medial condyle fracture of the distal humerus based on plain radiograph is difficult in children due to its cartilaginous structures. When a patient shows pain, tenderness and swelling on the medial side of the elbow, an additional examination with magnetic resonance imaging may be required even if no fracture line is found in the radiograph. Accurate diagnosis and early treatment is important for good results.

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Posterior-Posterior Dual Plates Fixation for the Distal Humerus Fractures: Yoon Min Lee, Seok Whan Song, Ki Bum Choi, Yoo Joon Sur, Sung Eun Kim; J Korean Fract Soc 2013;26(4):254-260. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.254

Abstract PDF

PURPOSE
Fractures of the distal humerus are one of the challenging injuries due to its complex anatomy and accompanied comminution. For dual plate fixation, orthogonal or parallel plating is widely used, but the better of the two is debatable. The purpose of this study was to report another fixation technique that yielded good clinical results with early bone union of distal humerus fracture, namely, posterior-posterior plate fixation.
MATERIALS AND METHODS
From March 2003 to March 2012, 20 patients with distal humerus fractures were treated by posterior-posterior plate fixation. The triceps reflecting approach was used with anterior transposition of the ulnar nerve. The mean age at the time of injury was 45 years (range, 26 to 78 years). By AO classification of distal humerus fractures, there were one case of A2 and B3 respectively, two cases of each A3, C1 and C3, and twelve cases of C2.
RESULTS
The mean period of complete bone union was 7.1 weeks (range, 4 to 11 weeks). The mean flexion-extension range of motion of the elbow joint at last follow-up was 116.2 degrees. The mean pronation was 81.2 degrees and supination was 83.1 degrees. Plates and screws were removed at about nine months after the initial surgery. No cases showed complications or required additional operation.
CONCLUSION
Posterior-posterior dual plates fixation resulted in stable bicortical screw fixation, and insertion of lag screws were possible without interference. Posterior-posterior plating could be an easy and stable fixation method that provides good clinical results.

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Does posterior configuration have similar strength as parallel configuration for treating comminuted distal humerus fractures? A cadaveric biomechanical study
Chien-An Shih, Fa-Chuan Kuan, Kai-Lan Hsu, Chih-Kai Hong, Cheng-Li Lin, Ming-Long Yeh, Wei-Ren Su
BMC Musculoskeletal Disorders.2021;[Epub] CrossRef

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Clinical Results of Various Surgical Techniques for Isolated Fracture of Greater Tuberosity of Humerus: Nam Su Cho, Seong Cheol Moon, Yong Girl Rhee; J Korean Fract Soc 2013;26(2):133-139. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.133

Abstract PDF

PURPOSE
To compare the clinical and radiologic outcomes of various surgical techniques for an isolated fracture of greater tuberosity of the humerus.
MATERIALS AND METHODS
From February 2001 to December 2008, 31 patients, who underwent an operation for isolated greater tuberosity fracture and were followed up for more than 1 year, were enrolled in this study. The mean age at the time of operation was 49.3 years (range, 23-73 years). The operation methods included in this study were as follows: a transosseous suture using nonabsorbable suture material (16 cases), a fixation by cannulated screws (10 cases), tension band wiring (2 cases), bony fragment excision with rotator cuff repair (2 cases), and percutaneous pinning (1 case).
RESULTS
At the last follow-up, the average Constant score was 79.4 and Korean Shoulder Score (KSS) was 81.2. Among the various operation methods used in this study, the transosseous suture had the highest scores with 82.5 in Constant score and 89.3 in KSS. Bone union was achieved at average 10.3 weeks (range, 7-15 weeks), and there were 2 cases in which the reoperation was required due to internal fixation failure. Postoperative shoulder stiffness occurred in 3 cases, and all the cases were done with the deltopectoral approach.
CONCLUSION
Clinically and radiologically satisfactory results were obtained using various operation techniques for an isolated greater tuberosity fracture of the humerus. The transosseous suture showed relatively better results than the other methods used in this study. To achieve favorable clinical and radiologic results, it is important to select an appropriate surgical approach and fixation method according to the fracture site, degree of displacement, and size of fragment.

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Biomechanical comparisons of hook plate and screw fixations in split-type greater tuberosity fractures of the humerus
Fa-Chuan Kuan, Kai-Lan Hsu, Chih-Kai Hong, Yueh Chen, Chen-Hao Chiang, Hao-Ming Chang, Wei-Ren Su
Journal of Shoulder and Elbow Surgery.2022; 31(6): 1308. CrossRef

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A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus: Sung Weon Jung; J Korean Fract Soc 2013;26(1):8-13. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.8

Abstract PDF: PURPOSE
To evaluate clinical and radiological outcomes for the comminuted metadiaphyseal fractures of the proximal humerus treated with a separate minimally invasive approach deltopectoral approach for fracture fragment reduction and deltoid splitting approach for cephalo-diaphyseal plate fixation.
MATERIALS AND METHODS
Eighteen patients (6 men and 12 women), who underwent surgery between March 2007 and February 2011, were included. A deltopectoral approach was used to expose and reduce the fracture fragments and an additional deltoid splitting approach was used to expose the humeral head. A locking plate was inserted under the muscle window and a cephalo-diaphyseal fixation was performed. All patients were examined and interviewed using the Visual Analog Scale (VAS) score, Constant score and standardized X-rays to check the time to fracture healing, neck-shaft angle (NSA).
RESULTS
All fractures were united, and mean healing time was 20 weeks. The average VAS score was 3.5 points (range, 0-5) and the average Constant score was 66.5 points (range, 30-90). Final functional outcomes were four cases of excellent, six cases of good, six cases of fair and two cases of poor. The average NSA was 127.5degrees (range, 100-140).
CONCLUSION
A separate approach and cephalo-diaphyseal plate fixation in operative treatment of the metadiaphyseal fractures of the proximal humerus is an effective, reliable treatment option that could reduce the fracture fragments accurately, with less dissection of the soft tissue and lower the complications. A further study including many cases and longer follow-up will be needed to improve the quality of the study.

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Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis: Youn Soo Hwang, Kwang Yeol Kim, Hyung Chun Kim, Su Han Ahn, Dong Eun Lee; J Korean Fract Soc 2013;26(1):14-20. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.14

Abstract PDF: PURPOSE
To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail.
MATERIALS AND METHODS
Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score.
RESULTS
All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points.
CONCLUSION
The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.

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Humerus Shaft Fractures in Leisure Sport 'Flyfish Riding': 4 Cases Report: Bong Gun Lee, Ki Chul Park, Youn Ho Choi, Woo Sung Jung, Kyu Tae Hwang; J Korean Fract Soc 2012;25(4):327-330. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.327

Abstract PDF

A fracture of the humeral shaft can occur by direct or indirect injury. Most occur as a result of direct injury mechanisms such as falls from a height, direct blows, and traffic accidents. Recently, the population enjoying watersports for leisure is increasing and 'flyfish riding', in which passengers ride an inflatable raft drawn by a motorboat, may cause humeral shaft fracture as twisting and axial compression forces occur on the humeral shaft while boarding. Accordingly, the incidence of humeral shaft fracture is expected to increase as more people are expected to enjoy leisure sport activities such as 'flyfish riding'. We report 4 cases of humeral fracture that occurred during this activity in the year 2011.

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Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis
Hongri Li, Wan Sun Choi, Bong-gun Lee, Jae-hoo Lee, Younguk Park, Doohyung Lee
The Korean Journal of Sports Medicine.2019; 37(4): 134. CrossRef

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Treatment of Non-union Distal Humerus Fractures after Operation: Hyung Sik Kim, Ki Joon Jang, Yun Rak Choi, Il Hyun Koh, Ho Jung Kang; J Korean Fract Soc 2012;25(4):310-316. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.310

Abstract PDF

PURPOSE
This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis.
MATERIALS AND METHODS
Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score.
RESULTS
Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported.
CONCLUSION
Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.

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Autogenous Inlay Bone Graft for Distal Humerus Nonunion with Metaphyseal Bone Defect: A Technical Note
Yong-Suk Lee, Dongmin Kim, Min-Sung Kang, Jong-Hwa Park, Sang-Uk Lee
Archives of Hand and Microsurgery.2020; 25(1): 39. CrossRef

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Minimally Invasive Plate Osteosynthesis for Humeral Proximal or Distal Shaft Fractures Using a 3.5/5.0 Metaphyseal Locking Plate: Hyoung Keun Oh, Suk Kyu Choo, Jung Il Lee, Dong Hyun Seo; J Korean Fract Soc 2012;25(4):305-309. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.305

Abstract PDF

PURPOSE
Our study aimed to investigate the clinical and radiological results of humerus proximal or distal shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using a 3.5/5.0 metaphyseal locking plate.
MATERIALS AND METHODS
We reviewed the clinical and radiographic records of 17 patients with humeral proximal or distal shaft fractures who had undergone 3.5/5.0 metaphyseal locking plate osteosynthesis with a minimally invasive technique. We evaluated the results with respect to the anatomical reduction and union of the humerus shaft fracture through radiologic studies. We also evaluated the clinical results using the motion of shoulder and elbow functional outcome, American Shoulder and Elbow Surgeons (ASES) score, Mayo elbow performance score (MEPS), and postoperative complications.
RESULTS
Complete union was achieved in all cases. The mean union time was 14.2 weeks. According to the functional outcome rated by the ASES score and MEPS, 15 cases were considered excellent and 2 cases were good. There were no cases of surgically-related complications like metal failure, loss of anatomical reduction, or postoperative nerve injuries.
CONCLUSION
Using a 5.0 metaphyseal locking plate for humerus shaft fracture has the limitation that difficulties can arise in achieving sufficient screw fixation for small bony fragments. The 3.5/5.0 metaphyseal locking plate used in MIPO for humerus 1/3 proximal or distal shaft fractures was concluded to give good clinical and radiologic results.

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Polarus Intramedullary Nail for Proximal Humeral and Humeral Shaft Fractures in Elderly Patients with Osteoporosis
Youn-Soo Hwang, Kwang-Yeol Kim, Hyung-Chun Kim, Su-Han Ahn, Dong-Eun Lee
Journal of the Korean Fracture Society.2013; 26(1): 14. CrossRef

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Combined Anterolateral and Lateral Approaches in Treatment of Extra-articular Fracture of the Distal Humerus: Dae Gyu Kwon, Kyoung Ho Moon, Suk In Na, Byung Ki Shin, Tong Joo Lee; J Korean Fract Soc 2012;25(3):185-190. Published online July 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.3.185

Abstract PDF

PURPOSE
The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve.
MATERIALS AND METHODS
We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients' age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function.
RESULTS
Clinical union was observed at 10.8 weeks (6~20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were "excellent" and 10 cases were "good" or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0~15 degrees) of extension, and 131.5 degrees (120~145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5~32 weeks) on average. There were no nonunion, malunion, or infection complications.
CONCLUSION
The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.

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Posterior Dual Plating for Distal Shaft Fractures of the Humerus
Chul-Hyun Cho, Kwang-Yeung Jeong, Beom-Soo Kim
Journal of the Korean Fracture Society.2017; 30(3): 117. CrossRef
Modified Combined Approach for Distal Humerus Shaft Fracture: Anterolateral and Lateral Bimodal Approach
Tong Joo Lee, Dae Gyu Kwon, Suk In Na, Seung Do Cha
Clinics in Orthopedic Surgery.2013; 5(3): 209. CrossRef

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Delayed Brachial Artery Occlusion after Humeral Shaft Open Fracture: A Case Report: Chul Hyun Cho, Ki Cheor Bae, Kyung Jae Lee, Si Wook Lee; J Korean Fract Soc 2012;25(2):146-149. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.146

Abstract PDF

Although vascular injury after humeral fracture is very rare, it is a complication that has serious sequelae. It has been associated with proximal humeral fracture or shoulder dislocation in adults and humeral supracondylar fracture in children. However, delayed brachial artery occlusion after humeral shaft fracture has never been reported worldwide. Nevertheless, delayed brachial artery occlusion after humerus shaft fracture has the potential to cause serious complications in the short term as well as long term; therefore, it is essential to provide accurate diagnosis and prompt treatment. We report a case of delayed brachial artery occlusion after humeral shaft open fracture that was successfully treated with early diagnosis as well as effective treatment.

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Delayed presentation of brachial artery injury following fracture shaft humerus; whether amputate or salvage: A series of two cases
Bhanu Sharma, Sibashish Metia, Kavish Kapoor, Pankaj Poswal
Journal of Orthopedics, Traumatology and Rehabilitation.2018; 10(2): 137. CrossRef

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Surgical Treatment Using a Transolecranon Approach with a Dual Locking Plate for Unstable Intercondylar Fractures of the Humerus: Ji Kang Park, Yong Min Kim, Dong Soo Kim, Eui Sung Choi, Hyun Chul Shon, Kyoung Jin Park, Byung Ki Cho; J Korean Fract Soc 2012;25(2):129-135. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.129

Abstract PDF: PURPOSE
To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus.
MATERIALS AND METHODS
Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum's classification of ROM.
RESULTS
The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum's classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks.
CONCLUSION
Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.

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The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing: Ki Chan An, Yoon Jun Kim, Jang Suk Choi, Seung Suk Seo, Hi Chul Gwak, Dae Won Jung, Dong Woo Jeong; J Korean Fract Soc 2012;25(1):46-51. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.46

Abstract PDF

PURPOSE
For conservative treatment of shaft fractures, the butterfly fragments that were somewhat larger in the closed intra-medullary (IM) nailing. The results of treatment were monitored using radiography separately for the weight-bearing femur and non-weight-bearing humerus.
MATERIALS AND METHODS
27 from Group I and 31 from Group II. In the two groups, the displacement and angulation changes in the fragments, and the degree of improvement of these two factors, were compared using follow-up radiography.
RESULTS
The mean angulation of fragments in Groups I and II were 9.2degrees and 9.6degrees, and the mean degree of displacement of the fragments in Groups I and II were 16.7 mm and 21.2 mm, respectively. Follow-up radiography showed that the above factors improved in both groups. The degree of displacement was significantly lower in the normal cases than in the complicated cases (p=0.001).
CONCLUSION
Displacement and angulation gradually improved in both groups. It was found that the degree of displacement after the initial reduction is more important than the influence of anatomical position or weight bearing. This indicates that care should be taken when inserting IM nails to prevent displacement or angulation.

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Risk Factors for Failure of Nonsurgical Management of Ulnar Shaft Fractures
Carew C. Giberson-Chen, Cassandra M. Chruscielski, Dafang Zhang, Philip E. Blazar, Brandon Earp
The Journal of Hand Surgery.2025; 50(4): 497.e1. CrossRef
The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study
Giovanni Vicenti, Massimiliano Carrozzo, Vincenzo Caiaffa, Antonella Abate, Giuseppe Solarino, Davide Bizzoca, Roberto Maddalena, Giulia Colasuonno, Vittorio Nappi, Francesco Rifino, Biagio Moretti
International Orthopaedics.2019; 43(1): 193. CrossRef
Reply to “Letter to the Editor on: The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study”
Giovanni Vicenti, Massimiliano Carrozzo, Davide Bizzoca, Biagio Moretti
International Orthopaedics.2019; 43(6): 1545. CrossRef
Letter to the Editor on “The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study”
Shih-Jie Lin, Kevin Liaw, Tsan-Wen Huang
International Orthopaedics.2019; 43(6): 1543. CrossRef
The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study
Giovanni Vicenti, Massimiliano Carrozzo, Vincenzo Caiaffa, Antonella Abate, Giuseppe Solarino, Davide Bizzoca, Roberto Maddalena, Giulia Colasuonno, Vittorio Nappi, Francesco Rifino, Biagio Moretti
International Orthopaedics.2018;[Epub] CrossRef
Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments
Duk-Hwan Kho, Hyeung-June Kim, Byoung-Min Kim, Hyun-Ryong Hwang
The Korean Journal of Sports Medicine.2016; 34(2): 120. CrossRef
Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures
Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn
The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef

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Operative Treatment of Distal Humeral Comminuted Fractures with Orthogonal Plating: Joong Bae Seo, Jae Sung Yoo; J Korean Fract Soc 2011;24(3):243-248. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.243

Abstract PDF: PURPOSE
To analyze the results of operative treatment for Comminuted Fracture of Distal Humerus with Transolecranon approach and Orthogonal plating.
MATERIALS AND METHODS
The subjects were 22 patients with Comminuted fracture of humerus who were treated with Orthogonal plating. Patient's age, sex, type of fracture, surgical approach, method of fixation, time of operation, time of bony union, complication, range of motion were investigated, and Function of elbow was evaluated by functional evaluation of Riseborough and Radin, Mayo Elbow Performance Score (MEPS).
RESULTS
Age, sex, injuried arm, operation time were not related to postoperative result. Type C2 fractures showed better results in function and range of motion (ROM) than type C3 fractures. Also early rehabilitation was important to functional recovery and ROM. The postoperative ROM was average 110. Good were 16 cases, fair were 6 cases in functional evaluation of Riseborough and Radin. Excellent were 13 cases, good were 8 cases, fair was 1 case in MEPS.
CONCLUSION
Operative treatment with Transolecranon approach and Orthogonal plating showed favorable result on its function. Intraarticular comminution and early rehabilitation were closely related to postoperative function of elbow.

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Intramedullary Nailing for Complex Fractures of the Proximal and Midshaft of the Humerus: Chul Hyun Cho, Gu Hee Jung, Kyo Wook Kim; J Korean Fract Soc 2011;24(3):237-242. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.237

Abstract PDF: PURPOSE
To evaluate the results of antegrade interlocking intramedullary nailing for complex fractures of the proximal and midshaft of the humerus.
MATERIALS AND METHODS
We retrospectively analyzed the clinical and radiologic results in 11 cases, which were treated by antegrade interlocking intramedullary nail. We assessed clinical outcomes according to ASES scoring system and radiological result.
RESULTS
All cases had bony union and the mean union period was 14.7 weeks. Postoperative complications were 1 loss of fixation, 2 proximal protrusion of nail and 2 temporary shoulder pain. A case with loss of fixation was treated open reduction and refixation and had union at 14 weeks postoperatively. The mean ASES score was 85.9 and the clinical outcomes were 4 excellent, 5 good, 1 fair and 1 poor.
CONCLUSION
Intramedullary nailing for complex fractures of the proximal and midshaft of the humerus can offer a reliable treatment option.

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Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing: A Case Report: Jae Hyuk Shin, Ho Guen Chang, Young Woo Kim, Nam Kyou Rhee, Yong Bok Park, Yong Kuk Kim; J Korean Fract Soc 2011;24(2):185-190. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.185

Abstract PDF

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

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Locking compression plate fixation of periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture: A case report
Mei-Ren Zhang, Kui Zhao, Jiang-Long Guo, Hai-Yun Chen
Trauma Case Reports.2022; 37: 100565. CrossRef
Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture
Hiren M. Divecha, Hans A. J. Marynissen
Case Reports in Orthopedics.2013; 2013: 1. CrossRef

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Comparison of Results between Internal Plate Fixation and Hemiarthroplasty in Comminuted Proximal Humerus Fracture: Doo Sup Kim, Dong Kyu Lee, Chang Ho Yi, Jang Hee Park, Jung Ho Rah; J Korean Fract Soc 2011;24(2):144-150. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.144

Abstract PDF

PURPOSE
Authors compare clinical and radiological results of internal fixation group and hemiarthroplasty group for comminuted proximal humerus fracture to find out which the treatment method have to be chose for comminuted proximal humerus fractures.
MATERIALS AND METHODS
Patients who were treated from March 2005 to March 2007 and available for 2 years follow-up were targets of this study. The internal fixation group had 38 cases, and hemiarthroplasty group included 26 cases. The results were analyzed both clinically and radiologically.
RESULTS
On average, Bone union took 15.6 weeks in the internal fixation group. Constant score between the internal fixation and hemiarthroplasty groups were on average 75+/-6.5 points and 70+/-7.4 points (p=0.034). In 3-part fracture, Constant score between both groups were 78+/-5.4 points from the former and 71+/-2 points, respectively (p=0.028). In 4-part fracture group, Constant score were 72+/-8 points for the internal fixation group and 69+/-9.2 points for the hemiarthroplasty group (p=0.041).
CONCLUSION
Internal plate fixation can gain better outcome than hemiarthroplasty in 4-part fracture as well as 3-part fracture of proximal humerus by careful dissection for preservation of blood supply for humeral head and optimal reduction.

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Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis
Erik Hohmann, Natalie Keough, Vaida Glatt, Kevin Tetsworth
European Journal of Orthopaedic Surgery & Traumatology.2022; 33(6): 2215. CrossRef
Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review
Long Chen, Fei Xing, Zhou Xiang, Ara Nazarian
PLOS ONE.2016; 11(11): e0166801. CrossRef
Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures
Jiezhi Dai, Yimin Chai, Chunyang Wang, Gen Wen
European Journal of Orthopaedic Surgery & Traumatology.2014; 24(3): 305. CrossRef

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