Successful experience in treating an open fracture of the lower third of the humerus with displacement of fragments and rupture of the radial nerve

Authors:

Yamshikov Oleg Nikolaevich – Grand PhD in Medical Sciences (Dr. Med. Sci.), Professor, Head of the Department of Hospital Surgery with a Traumatology Course, Institute of Medicine and Health Preservation, Tambov State University named after G.R. Derzhavin, 33 International Street, 392000 Tambov, Russian Federation; chief physician of the City Clinical Hospital of Kotovsk, 24 Pionerskaya Street, 393190 Kotovsk, Russian Federation; e-mail: travma68@mail.ru; https://orcid.org/0000-0001-6825-7599.

Emelyanov Sergey Alexandrovich – PhD in Medical Sciences (Cand. Med. Sci.), Associate Professor of the Department of Hospital Surgery with a Course of Traumatology, Institute of Medicine and Health Preservation, Tambov State University named after GR Derzhavin, 33 Internatsional’naya Street, 392000 Tambov, Russian Federation; deputy chief physician of the City Clinical Hospital of Kotovsk, 24 Pionerskaya Street, 393190 Kotovsk, Russian Federation; e-mail: cep_a@mail.ru; https://orcid.org/0000-0001-6825-7599.

Chumakov Roman Vyacheslavovich – Assistant Professor of Hospital Surgery, Resident in the specialty Radiology at Tambov State University named after G.R. Derzhavin, Institute of Medicine and Health Preservation, 33 International Street, 392000 Tambov, Russian Federation; e-mail: roman68881@yandex.ru; https://orcid.org/0000-0003-2586-3489.

Akulinin Danila Andreevich – student of the Institute of Medicine and Health Preservation, Tambov State University named after G.R. Derzhavin, 33 International Street, 392000 Tambov, Russian Federation; akulinin2001@yandex.ru; https://orcid.org/0009-0008-3312-0769.

Annotation:

Introduction. Large vascular-nerve bundles pass along the elbow joint, damage to which can lead to subsequent dysfunction of the upper limb. Fractures of the lower third and condyles of the humerus account for about 30 % of all fractures of the humerus. This type of fracture requires surgical treatment, preserving the maximum possible functions of the underlying parts of the upper limb.

Aim. Demonstration of successful experience in treating a patient with an open fracture of the distal metaepiphysis of the humerus with concomitant displacement of fragments and a complication in the form of a rupture of the radial nerve at the fracture site.

Materials and methods. Description of a clinical case and a brief analysis of the literature on this topic. The search was conducted in open electronic scientific databases PubMed and databases of the Russian scientific electronic library elibrary using keywords and phrases: humerus fracture, distal section, elbow joint, surgical treatment, osteosynthesis, titanium plates, Kirschner wires. The results were obtained using the equipment of the Center for Collective Use of Scientific Equipment of the Derzhavin Tomsk State University.

Results. The left olecranon was repositioned and osteosynthesis was performed according to Weber, after access was obtained through it using the osteotomy method. The patient was discharged in a satisfactory condition 23 days after the operation, outpatient treatment was recommended by a traumatologist and neurologist at the place of residence.

Discussion. Analyzing the results of surgical treatment in the described clinical case, we can conclude that the method of osteosynthesis with Kirschner wires is highly effective in open comminuted fractures of the distal metaepiphysis of the humerus with a wound surface, including those complicated by a rupture of the radial nerve.

Conclusion. For successful treatment of humeral fractures, a prerequisite is the precise alignment of fragments and ensuring complete immobilization of the damaged area, followed by complex therapy. Our experience allows us to believe that treatment with the method of osteosynthesis with Kirschner wires is effective in open comminuted fractures of the distal metaepiphysis of the humerus.

List of cited literature:

1. Mellstrand Navarro C, Brolund A, Ekholm C, Heintz E et al. Treatment of humerus fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and evolution of practice. PLoS One. 2018 Dec 13;13(12):e0207815. DOI: 10.1371/journal. pone.0207815.

2. Handoll HH, Elliott J, Thillemann TM, Aluko P et al. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2022 Jun 21;6(6):CD000434. DOI: 10.1002/14651858. CD000434.pub5.

3. Handoll H, Brealey S, Rangan A, Keding A et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial – a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015 Mar;19(24):1-280. DOI: 10.3310/ hta19240.

4. Asyanin SA. Fizicheskaja reabilitacija sportsmenov s porazhenijami myshc plechevogo pojasa [Physical rehabilitation of athletes with lesions of the shoulder girdle muscles]. Travmatologija, ortopedija, vossta-novitel’naja hirurgija. Materialy konferencii. T. XLV [Traumatology, orthopedics, reconstructive surgery. Conference Proceedings. Vol. XLV]. Kazan, 1997:42-3. (In Russian).

5. Ciminello E, Modesti A, Romanini E, Lepore S et al. Trends and Changes in Treating Proximal Humeral Fractures in Italy: Is Arthroplasty an Increasingly Preferred Option? A Nation-Wide, Population-Based Study over a Period of 22 Years. J Clin Med. 2024 Sep 27;13(19):5780. DOI: 10.3390/jcm13195780.

6. Leino OK, Lehtimaki KK, Makela K, Aarimaa V et al. Proximal humeral fractures in Finland: trends in the incidence and methods of treatment between 1997 and 2019. Bone Joint J. 2022 Jan;104-B(1):150-6. DOI: 10.1302/0301-620X.104B1.BJJ-2021-0987.R1.

7. McLean AS, Price N, Graves S, Hatton A et al. Nationwide trends in management of proximal humeral fractures: an analysis of 77,966 cases from 2008 to 2017. J Shoulder Elbow Surg. 2019 Nov;28(11):2072-8. DOI: 10.1016/j.jse.2019.03.034.

8. Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohe K et al. Trends in surgical management of proximal humeral fractures in adults: a national study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019 Dec;139(12):1713-21. DOI: 10.1007/s00402-019-03252-1.
9. Yigit §. What should be the timing of surgical treatment of humeral shaft fractures? Medicine (Baltimore). 2020 Apr;99(17):e19858. doi: 10.1097/ MD.0000000000019858.

10. Bogolyubsky YA, Fain AM, Vaza AY et al. Travmaticheskie i jatrogennye povrezhdenija luchev-ogo nerva pri perelomah diafiza plechevoj kosti [Traumatic and iatrogenic injuries of the radial nerve in fractures of the humeral shaft]. Prakticheskaja me-dicina [Practical medicine]. 2022. 20(4):109-16. 3. (In Russian).

11. Ramo L, Sumrein BO, Lepola V, Lahdeoja T et al. Effect of Surgery vs Functional Bracing on Functional Outcome Among Patients With Closed Displaced Humeral Shaft Fractures: The FISH Randomized Clinical Trial. JAMA. 2020 May 12;323(18):1792-1801. DOI: 10.1001/jama.2020.3182.

12. Barabash YuA, Barabash AP, Grazhdanov KA. Jeffektivnost’ vidov osteosinteza pri perelomah plech-evoj kosti i ih posledstvijah [Effectiveness of types of osteosynthesis in fractures of the humerus and their consequences]. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij [International Journal of Applied and Fundamental Research]. 2014;10(2):76-80. (In Russian).

13. Belenkiy IG, Mayorov BA, Li SK. Operativnoe lechenie perelomov diafiza plechevoj kosti. sovremennyj vzgl-jad na problemy i puti ih reshenija [Surgical treatment of humeral shaft fractures. a modern view of the problems and ways to solve them]. Fundamental’nye issle-dovanija [Fundamental Research].2014;10(9):1849-57. (In Russian).