Abstract: Fractures of the humeral shaft are common, accounting for approximately 3% of all Orthopaedic injuries according to a study by World Health Organization [1], and result in a significant burden to society from lost productivity and income. These humeral shaft fractures have traditionally been regarded 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 accepted [2, 3].
Study Duration: 1st April 2018 to 1st April 2019
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 required surgery had careful pre- operative 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. 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.
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 dominant 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 little complications. Operative management by plating appears to be method of choice for internal fixation. All patients in this study were fixed by this method.
