Biological Osteosynthesis in Midshaft

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Jaypalsinh B. Parmar
Nitin S. Patil
Mohit Nadkarni
Yash Ratanpal


The humerus is the longest bone in the upper extremity and plays a crucial role in the limb's capacity to function. Humerus Shaft Fractures Account for 1-2% of All Fractures in the Body. Open reductions & internal fixation with such a Dynamic compression plate, lock compression slab, aside a few minutes Dynamic Compression Plate, intra - medullary nail, or minimally invasive bridge plate is one common surgical therapy for humeral shaft fractures. Two techniques for Mid-shaft Humerus Fracture under the study include Intra-medullary nailing and Anterior Bridge Plating, both these fix two main fragments, while the intermediate fracture zone is left untouched. Intramedullary interlocking nailing acts as a load-sharing implant, whereas Anterior Bridge plating (ABP) employs the plate as just an extra-medullary splint. Problems with overhead motion were seen by patients whose incisions were nailed through the rotator cuff, although ABP offers benefits over the other method since it does not harm the rotator cuff. It also requires less time in surgery and fewer doses of radiation. Aim And Objectives: To compare the functional outcome of midshaft humerus fracture treated with anterior bridge plating and Antegrade intramedullary Interlocking nailing by evaluating the time of fracture union, comparing DASH score, evaluating the efficacy of each treatment modality in society (majority of which are farmers and labourers) -According to patient satisfaction. Material and methodology: this is a prospective comparative randomisedstudyconducted in the department of orthopaedics, Krishna institute of medical sciences, Karad which includes 60 patients of midshaft humerus fracture treated with antegrade intramedullary nailing and anterior bridge plating (30 patients each). Results: The average age for Midshaft Humerus Fracture Treated with Antegrade intramedullary nailing was (37.4 ± 11.2) years with a range of 22-62 years and  Anterior Bridge Plating was (39.2 ± 11.4) years with a range of 18-62 years. Male predominance was noted in case distribution. The most common occupation was Farmer for men and housewife for women. The affected side distribution with Antegrade intramedullary nailing was more on the right side and Anterior Bridge Plating was equal for the right and left sides. The Bending Wedge Fracture (AO Type 12.B2) was common. The most common Mode of Injury was Road Traffic Accidents. The average time for Union with Antegrade intramedullary nailing was (14.766 ± 3.170) weeks, whereas with Anterior Bridge Plating it was (12.00± 2.779) weeks. In our study, no intraoperative complications were seen. In Antegrade intramedullary nailing, there were 2 cases of infection, one of which was a superficial infection which healed with appropriate antibiotics as determined by culture and sensitivity and there was 1 case of non-union seen at 1-year follow-up.In Anterior Bridge Plating, there was 1 case of Postoperative radial nerve palsy which recovered on conservative management post-operatively with Cock up Splint. The average DASH Score for Antegrade intramedullary nailing was (12.76 ± 1.78); whereas for Anterior Bridge Plating, it was (10.29 ± 0.592) at 6 months postoperatively. Patient Satisfaction in Farmers and Laborers for Antegrade intramedullary nailing was 71.42% (10/14)whereas with Anterior Bridge Plating it was 100% (11/11) at 6 months postoperatively. Conclusion: Anterior bridge plating has better long-term functional outcomes than antegrade intramedullary nails in midshaft humerus fracture treatment due to less fracture healing time, less DASH score, and better patient satisfaction in the majority of the population.

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Parmar , J. B., Patil , N. S. ., Nadkarni , M. ., & Ratanpal , Y. . (2023). Biological Osteosynthesis in Midshaft. Journal of Coastal Life Medicine, 11(1), 1383–1391. Retrieved from


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