Humeral fractures in veterinary patients are challenging to stabilize. This study is a biomechanical in vitro comparison of the performance of two locking plate constructs used to stabilize a canine distal humeral metaphyseal gap model. Two groups of canine cadaveric humeri were prepared. One group consisted of a unilateral medially placed locking plate (UNI). The second group consisted of bilateral locking plates (BI). Constructs were tested in torsion and axial compression. The UNI constructs had significantly lower stiffness in torsion and axial compression than the BI group. However, UNI constructs had a significantly higher ultimate strength than BI constructs. All UNI constructs failed by bending of the transcondylar screw and SOP plate. All BI constructs failed by axial pullout of the distal most screws. The clinical significance is that in stabilizing canine supracondylar humeral fractures as modeled here, both the UNI model and the BI model demonstrated biomechanical advantages.

Proximal humeral fractures requiring surgical stabilization remain a therapeutic challenge, and a fully functioning joint is rarely the outcome after traumatic proximal humeral fractures. A systematic review was conducted to present the current state of knowledge concerning the postoperative rehabilitation. Tree databases was searched (PubMed, PEDro and the Cochrane library), presenting 25 publications eligible for further review and assessment. The literature was evaluated using PEDro and The Swedish Council on Health Technology, SBUs, evaluation grading system GRADE. The main functional impairments were pain and reduced range of motion in the shoulder joint, and were measured by several different scoring systems for functional outcome. Reported results were contradictory and inconsistent, and current studies typically lack randomization, and independent evaluation, with a resultant inability to produce clinical conclusions. According the post-operative rehabilitation procedure, only careful conclusions can be drawn from the literature reviewed which does not focus on, emphasize or explore the physiotherapeutic interventions at any length. It was therefore not possible to compare or connect the Axelina rehabilitation regimen with the literature. The Axelina rehabilitation program of the shoulder joint, are the most commonly used regimen at the physiotherapeutic ward at Uppsala University hospital. Neither was it possible to determine if the post-operative treatment should be different according to classification of fracture or method of stabilization. The results from this systematic review suggest that the data from the published literature are inadequate for evidence-based decision making as regards the treatment and post-operative rehabilitation for complex proximal humeral fractures.

The treatment for the humeral shaft fractures in adults usually presents two possibilities of management: conservative treatment and surgical treatment. The conservative treatment is administered through the use of cast and the surgical treatment can be provided with the use of plates and screws or with the use of rigid intramedullary nails. Flexible intramedullary nails are widely used in the treatment of long bone fractures in children. We aim to use flexible intramedullary nails in the treatment for humeral shaft fractures in adults and assess the consolidation time, pain and the rehabilitation results. The research was conducted through the selection of twenty cases of humeral shaft fractures in adults in which the treatment was provided with the use of flexible intramedullary nails. The results were satisfactory, with good signs of approval regarding the management of the fractures. From the positive results that were obtained, we expect to increase the number of cases treated with flexible intramedullary nails and to compare them with control groups that have undergone other forms of treatment for these fractures. / O tratamento das fraturas da diáfise do úmero em adulto apresenta habitualmente duas possibilidades de condução: tratamento conservador e tratamento cirúrgico. O tratamento conservador é realizado com uso de aparelho gessado. O tratamento cirúrgico apresenta duas modalidades: uso de placas e parafusos e uso de hastes intramedulares rígidas. As hastes intramedulares flexíveis têm seu uso bem estabelecido no tratamento das fraturas de ossos longos em crianças. O objetivo desse trabalho foi utilizar as hastes intramedulares flexíveis na condução do tratamento das fraturas da diáfise do úmero em adultos e avaliar tempo de consolidação, dor e resultados de reabilitação. O presente estudo é ensaio clínico aberto, não randomizado, com um braço, com seleção sequencial de 20 casos de fraturas de diáfise de úmero em adultos nos quais o tratamento foi conduzido com o uso das hastes intramedulares flexíveis. O emprego de hastes intramedulares flexíveis resultou em índice de consolidação de 95%. A média de tempo entre a fratura e o retorno ao trabalho foi de 72,68 dias, e a média de tempo entre a cirurgia e o retorno ao trabalho foi de 60,89 dias. As médias dos ângulos de abdução do ombro, aos 21, 60 e 180 dias foram de 25,75º, 97,63º e 174,74º, respectivamente. Com base nesses resultados positivos obtidos, espera-se ampliar o número de casos tratados com as hastes intramedulares flexíveis e realizar um comparativo com grupos controles que sigam outras formas de tratamento destas fraturas.

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