Surgery Orthopedics A Retrospective Analysis of Plate Fixation of Humerus Fracture

Introduction: These fractures are mostly treated conservatively. Both the plate fixation and nailing techniques are being used but plate fixation has the advantage of lesser rates of malunion and non-union. Our study aimed to evaluate the results of plate fixation in our hospital that employs plate fixation as the golden standard. Materials and Methods: This was a retrospective cohort study of all patients treated for a humeral shaft fracture in our hospital (District Hospital Vidisha associated with ABV Medical College, Vidisha between July 2018 and June 2020 with a mean follow-up of 6 months. Results: Plate fixation was performed in 40 patients with a humeral shaft fracture. The mean age was 50 (SD 20) years with 60 % ( n = 24) being male. There were 55 % ( n = 22) fractures in the right and 45 % ( n =18) fractures in the left. None of the patients develops superficial surgical site infection. Complications like Radial Nerve palsy, Deep surgical site infections and Non-union occurred in 2.5 % ( n = 1), 2.5 % ( n = 1) and 5 % ( n = 2) of patients, respectively. The median duration of radiological fracture healing was 18 (range 10–42) weeks. Conclusion: Plate fixation for humeral shaft fractures has low risks of complications. The complications can be further minimized with greater surgical expertise.


Introduction
Humeral shaft fractures represent 1-3% of all the fractures coming in our OPD [1]. Currently, there are no defined gold standards for the treatment of humeral shaft fractures [2,3]. Most of these fractures are mostly treated conservatively.
Although nonoperative treatment has a long and successful history in certain cases [4]. It requires good patient compliance for a successful outcome.

Materials And Methods
This was a retrospective cohort study of all the patients treated for a humeral shaft fracture in our hospital (District Hospital Vidisha associated with ABV Medical College, Vidisha) between July 2018 and June 2020 with a mean follow-up of 6 months.

Inclusion criteria:
Both close and open fractures were included in the study

Exclusion criteria:
Both the lateral and AP view radiographs were obtained and based on X-ray; fracture was classified on basis of AO classification ( Fig 1 & 3). Humerus diaphyseal fracture was classified as type A (Simple), type B (wedge) and type C (Complex) [18]. The Gustilo-Anderson classification was used in cases of open fractures [19]. In our study, there were 3 such cases, two types 1 and one types 2 open wounds. Patients were operated under regional/general anesthesia in the supine or lateral position. All patients received a single dose of ceftriaxone 1 gram injection half an hour before surgery as antibiotic prophylaxis.
Tourniquet was not used during the surgery. 4.5 mm Locking Compression Plate (LCP) was used to fix the fracture (Fig 2& 4). Both the anterolateral, posterior, and minimally invasive approaches were

Results
The median hospital stay was 6 days (range 2-18).
Patients were followed up for 6 months. Patients (40%) cases. All fractures were fixed by a 4.5 mm narrow LCP plate (Fig 2 & 4). None of the patients develops superficial surgical site infection.
In one patient who developed radial nerve palsy postoperatively, the palsy recovered spontaneously in 4 months. In our study, we found no radial nerve palsy before surgery. In one case of deep surgical infection, culture sensitivity of wound was done and accordingly intra-venous antibiotic injections were given for 5 days postoperatively followed by oral antibiotics for next 9 days and the patient stayed in the hospital during this period for dressings. The patient was discharged when the wound healed and stitch removal was done.      In a study by Vichare (1972) he found that standard conservative methods of treatment in patients with multiple injuries can lead to a high incidence of malunion and non-union and so he devised a traction system to manage such fractures with multiple injuries [25]. However, an important aim in the management of these patients is to be able to sit them upright with pain-free extremities [26].
Failing this, prolonged recumbency may lead to considerable morbidity.
Early mobilisation of the limb helps to prevent the "fracture disease" [27]. In two recent reviews by The best treatment for humeral shaft fractures complicated with radial nerve injury is highly controversial [38,39]. While concomitant nerve injury has been used as an argument for the immediate surgical treatment of fractures in the past (using a posterior approach and visualizing the radial nerve) (40), recent investigations have shown no significant difference in radial nerve palsy recovery between initial operative and nonoperative management strategies [36,41].
Most radial nerve injuries in cases of humeral shaft fracture are caused by traction or compression of the nerve, which is known as neuropraxia. Much fewer nerve injuries are identified as discontinuity of the nerve (axonotmesis or neurotmesis) [42].
Neuropraxia is a reversible injury, resulting in spontaneous reversibility in a large portion of traumatic radial nerve palsy cases (36). Plate fixation is the golden standard in our hospital.
Our study included only those cases of humerus fractures that were managed surgically by plate fixation It is a well-known fact that a higher level of training generally yields better results [43,44)]. This These proportions are comparable to those found in similar studies [47,48,49]. Nevertheless, functional results are equally important to take into consideration when determining the optimal treatment for patients with humeral shaft fractures. There were several limitations in our study that should be considered when interpreting the results. It was a retrospective study and will have certain amounts of selection bias.
Also, the ability to fully weight bear is a subjective outcome that ideally should be measured on a day to day basis using but it was determined at fixed intervals when the patient was called for follow up.
Consequently, this outcome is also determined by the length of the intervals. This applies to a lesser extent for radiological fracture union as changes in radiographs require several weeks to become detectable.