Functional Outcome of Operative Management of Humeral Shaft Fractures

Gichunge, Peter Munene (2015) Functional Outcome of Operative Management of Humeral Shaft Fractures. Masters thesis, University of Nairobi.

PDF (Functional Outcome of Operative Management of Humeral Shaft Fractures) Gichunge_Functional outcome of operative management of humeral shaft fractures.pdf - Accepted Version Restricted to Repository staff only Download (853kB) | Request a copy

Abstract

Fractures of the humeral shaft are common, accounting for approximately 3% of all orthopaedic injuries according to a study by World Health Organization1, and result in a significant burden to society from lost productivity and income. These humeral shaft fractures have traditionally beenregarded as benign, with high percentage of primary healing with conservative methods. However loss of reduction in the plaster cast invariably leads to malunion. Surgery is however indicated in some of these patients for optimum outcome. With improved implant design and surgical technique, operative management of humeral shaft fractures has increasingly become accepted2, 3. Most of the studies have used fracture union as the major determinant of the outcome and very few studies have examined the functions at the shoulder and elbow. PURPOSE To study functional outcome of operative management of humeral shaft fractures VARIABLES TO BE EVALUATED Age of the patient, etiology/cause of trauma, time and place of injury, occupation of the patient, associated injuries (e.g. neuro-vascular status, tendon injury), pain, instability, activities of daily living, motion and function. STUDY DESIGN Prospective Analytical Study SETTING Kenyatta National Hospital and PCEA Kikuyu Hospital Orthopedic surgery wards, clinics and casualty STUDY DURATION 1st April 2013 to 1st April 2014 METHODS AND MATERIALS Purposive sampling method was used to select 45 patients who sustained humeral shaft fractures requiring surgery. A thorough history and clinical examination was done. Age of the patient, etiology/cause of trauma, time and place of injury, occupation of the patient, associated injuries were recorded in a trauma sheet. Patients who presented to hospital immediately after injury and requiredsurgery had careful preoperative planning done. Blood investigations were taken and pre-operative review done by anaesthetist. Surgery was done under general anesthesia and prophylactic antibiotics were administered in all cases. Treatment consisted of a standard posterior triceps-splitting approach to the humerus. The radial nerve was identified and protected for the duration of the procedure. A dorsal 3.5mm or 4.5mm DCP plate was utilized. A minimum of eight cortices of fixation above and below the fracture site were obtained. Postoperatively, anteroposterior and lateral radiographs were done to assess alignment and reduction of fractures. Patients were placed in an arm sling primarily for comfort for two weeks. Gentle pendulum and active assisted shoulder and elbow range of motion were started at 2 weeks post-surgery followed by strengthening and passive range of motion exercises 4. Patients were reviewed at 2, 6, 12 and 24 weeks. The primary outcomes measured were time to union, function and complications. Union was determined by radiographic evidence of cortical bone bridging at the fracture site, stable hardware position on radiographs, as well as absence of pain with manual palpation of the fracture site. X-rays were taken immediately post operatively, at 6 weeks and at 6 months. Assessment for pain at the fracture site and evidence of union were checked at 6 weeks, while functional outcome using ASES and Mayo Elbow Performance scores were done at 6 months. DATA COLLECTION AND STATISTICAL ANALYSIS The researcher collected data from the patients. Predesigned data collection sheets were used. The data was analyzed using SPSS version 19 and descriptive statistics for sample variables presented in form of tables and graphs. Repeated measures ANOVA were used to show any variations in the dependent variables while Pearson’s correlation was used to check for any existing relationship in the variables. Data was considered significant at p≤0.05 and presented with 95% confidence interval. Data collected was analyzed and presented in the form of tables and charts. RESULTS 45 patients with humeral shaft fractures were managed operatively by plating. The mean age was 34.6 years. Men accounted for 68.9% (31 out of 45) of the cases. Of these 38 were right hand dorminant while the rest were left handed.26 patients had right humeral shaft fractures while 19 had the left humerus affected. Sixteen patients experienced shoulder pains while 19 were on pain medications. The median shoulder functionality scores in the different age groups ranged from 80 to 85 out of 100. The oldest age group (45 years and above) had lower scores with median score of 80 and range 48.3 to 85.The duration of healing was about 6 months. CONCLUSION AND RECOMMENDATIONS The results of this study indicate operative management of humeral shaft fractures results in good functional outcomes with few complications. Operative management by plating appears to be method of choice for internal fixation. All patients in this study were fixed by this method. Studies should be done in future comparing functional outcomes of different operative modalities. Studies have been done in other countries which compare plating and nailing of humeral shaft fractures with reported good results. In patients with indications for operative management of humeral shaft fractures, plating can be done because of good functional outcomes and healing potential. Special attention though has to be made to avoid damage to the radial nerve.

Item Type:	Thesis (Masters)
Subjects:	R Medicine > R Medicine (General) R Medicine > RD Surgery
Divisions:	Africana
Depositing User:	Mr Nahum Osman
Date Deposited:	24 Oct 2016 12:06
Last Modified:	24 Oct 2016 12:06
URI:	http://thesisbank.jhia.ac.ke/id/eprint/985

Actions (login required)

View Item