Skip to main content

Advertisement

Log in

Fratture esposte di omero e di gomito

Open humerus and elbow fractures

  • Aggiornamenti
  • Published:
LO SCALPELLO-OTODI Educational

Abstract

Humeral and elbow fractures are much rarer than those of the lower limbs and represent about 10% of all fractures. We performed a review of the literature and reported our experience in the management of these fractures. The technique mainly depends on the degree of exposure and contamination of the wound as happens for other fractures. From a close examination of the literature, which is really small, it appears that the main treatment for humeral fractures remains external fixation as an emergency stabilisation, and as final solution in case of severe mortification of muscle tissue. In case of distal humeral fracture or, in particular, of articular injuries classified as Gustilo I and II, a stable surgical treatment with plates or bone graft or dynamic fixator can be indicated for early mobilisation. In case of proximal forearm articular fractures with moderate bone exposition, the patient can be treated by stable ulnar fixation and radial reconstruction (if needed, with radial head prosthesis), if managed within six hours after the injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Bibliografia

  1. Camuso MR (2006) Far-forward fracture stabilization: external fixation versus splinting. J Am Acad Orthop Surg 14:S118–S123

    Article  PubMed  Google Scholar 

  2. Rush RM, Beekley AC, Puttler EG et al. (2009) The mangled extremity. Curr Prob Surg 46:851–926

    Article  Google Scholar 

  3. Brinker MR, O’Connor DP (2004) The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Jt Surg, Am Vol 86:290–297

    Article  Google Scholar 

  4. Ekholm R, Adami J, Tidermark J et al. (2006) Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Jt Surg, Br Vol 88:1469–1473

    Article  CAS  Google Scholar 

  5. Sarmiento A, Kinman PB, Galvin EG et al. (1977) Functional bracing of fractures of the shaft of the humerus. J Bone Jt Surg, Am Vol 59:596–601

    Article  CAS  Google Scholar 

  6. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg, Am Vol 58:453–458

    Article  CAS  Google Scholar 

  7. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746

    Article  CAS  PubMed  Google Scholar 

  8. Mirić D, Senohradski K, Starcević B, Djordjević Z (2004) External fixation war injuries of the proximal humerus. Srp Arh Celok Lek 132(3–4):92–95

    PubMed  Google Scholar 

  9. Golubović Z, Vukašinović Z, Stanić V et al. (2011) External fixation in the treatment of shooting proximal humeral fracture with bone defect: a case report. Srp Arh Celok Lek 139(5–6):370–375

    Article  PubMed  Google Scholar 

  10. Fornara P, Grassi FA (2009) Fratture dell’omero prossimale. La sintesi percutanea: ha ancora un ruolo? Lo Scalpello 23:12–17

    Article  Google Scholar 

  11. Soete PJ, Clayson PE, Costenoble VH (1999) Transitory percutaneous pinning in fractures of the proximal humerus. J Shoulder Elbow Surg 8:569–573

    Article  CAS  PubMed  Google Scholar 

  12. Jaberg H, Warner JJ, Jakob RP (1992) Percutaneous stabilization of unstable fractures of the humerus. J Bone Jt Surg, Am Vol 74:508–515

    Article  CAS  Google Scholar 

  13. Kerkhoffs GM, Kuipers MM, Marti RK et al. (2009) External fixation with standard AO plates: technique, indications and results in 31 cases. J Orthop Trauma 23:72–75

    Article  Google Scholar 

  14. Heineman DJ, Poolman RW, Nork SE et al. (2010) Treatment of humeral shaft fractures-meta-analysis reupdated. Acta Orthop 81:216–223

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rich NM, Netz CW Jr, Baugh JA, Hughes CW (1971) Internal versus external fixation of fractures with concomitant vascular injuries in Vietnam. J Trauma 6:463–473

    Google Scholar 

  16. Choong PF, Griffiths JD (1988) External fixation of complex open humeral fractures. Aust NZ J Surg 58:137–142

    Article  CAS  Google Scholar 

  17. Gausepohl T, Koebke J, Pennig D et al. (2000) The anatomical base of unilateral external fixation in the upper limb. Injury 31(Suppl 1):11–20

    Article  PubMed  Google Scholar 

  18. Marsh JL, Mahoney CR, Steinbronn D (1999) External fixation of open humerus fractures. Iowa Orthop J 19:35–42

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Hinsenkamp MB, Andrianne Y (1984) External fixation of the fractures of the humerus: a review of 164 cases. Orthopedics 7:1309–1314

    CAS  PubMed  Google Scholar 

  20. Suzuki T, Hak DJ, Stahel PF et al. (2010) Safety and efficacy of conversion from external fixation to plate fixation in humeral shaft fractures. J Orthop Trauma 24(7):414–419

    Article  PubMed  Google Scholar 

  21. Kundel K, Braun W, Wieberneit J, Reuter A (1996) Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res 332:200–208

    Article  Google Scholar 

  22. Roberts CS, Pape H-C, Jones AL et al. (2005) Damage control orthopaedics: evolving concepts in the treatment of patients who have sustained orthopaedic trauma. J Bone Jt Surg, Am Vol 87:434–449

    Article  Google Scholar 

  23. Min W, Anwar A, Ding BC, Tejwani NC (2010) Open distal humerus fractures—review of the literature. Bull NYU Hosp Jt Dis 68:257–261

    PubMed  Google Scholar 

  24. Dowrick AS, Gabbe BJ, Williamson OD, Cameron PA (2005) Outcome instruments for the assessment of the upper extremity following trauma: a review. Injury 36:468–476

    Article  PubMed  Google Scholar 

  25. Kömürcü M, Yanmiş I, Ateşalp AS, Gür E (2003) Treatment results for open comminuted distal humerus intra-articular fractures with Ilizarov circular external fixator. Mil Med 168:694–697

    PubMed  Google Scholar 

  26. Ring D, Jupiter JB, Toh S (1999) Salvage of contaminated fractures of the distal humerus with thin wire external fixation. Clin Orthop Relat Res 359:203–208

    Article  Google Scholar 

  27. Chaudhary S, Patil N, Bagaria V et al. (2008) Open intercondylar fractures of the distal humerus: management using a mini-external fixator construct. J Shoulder Elbow Surg 17:465–470

    Article  PubMed  Google Scholar 

  28. Cassebaum WH (1969) Open reduction of T & Y fractures of the lower end of the humerus. J Trauma 9:915–925

    Article  CAS  PubMed  Google Scholar 

  29. McKee MD, Kim J, Kebaish K et al. (2000) Functional outcome after open supracondylar fractures of the humerus. The effect of the surgical approach. J Bone Jt Surg, Br Vol 82:646–651

    Article  CAS  Google Scholar 

  30. Duckworth AD, Clement ND, Aitken SA et al. (2012) The epidemiology of fractures of the proximal ulna. Injury 43:343–346

    Article  PubMed  Google Scholar 

  31. Yi PH, Weening AA, Shin SR et al. (2014) Injury patterns and outcomes of open fractures of the proximal ulna do not differ from closed fractures. Clin Orthop Relat Res 472:2100–2104

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gursel S, Necdet S, Tuhan K et al. (2013) Interlocking intramedullary ulna nails in isolated ulna diaphyseal fractures: a retrospective study. Acta Orthop Traumatol Turc 47(4):236–243

    Article  Google Scholar 

  33. Ashford RU, Mehta JA, Cripps R (2004) Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures. Injury 35:411–416

    Article  PubMed  Google Scholar 

  34. Schenker ML, Yannascoli S, Baldwin KD et al. (2012) Does timing to operative debridement affect infectious complications in open long-bone fractures? A systematic review. J Bone Jt Surg, Am Vol 94A:1057–1064

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Russo.

Ethics declarations

Conflitto di interesse

Gli autori R. Russo e G. Della Rotonda dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and animal rights

Per questo tipo di studio non è richiesto l’inserimento di alcuna dichiarazione relativa agli studi effettuati su esseri umani e animali.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Russo, R., Della Rotonda, G. Fratture esposte di omero e di gomito. LO SCALPELLO 30, 23–30 (2016). https://doi.org/10.1007/s11639-016-0155-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11639-016-0155-y

Navigation