{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T12:39:34Z","timestamp":1770813574858,"version":"3.50.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this retrospective study, 109 patients were evaluated, who, during a period of 6\u00a0years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results and conclusion<\/jats:title>\n                <jats:p>The healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-021-01847-1","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T11:02:37Z","timestamp":1640948557000},"page":"3081-3087","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["New ways of treatment of fractures of the humeral shaft: does the combination of intramedullary nail osteosynthesis and cerclage improve the healing process?"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3954-8909","authenticated-orcid":false,"given":"Franziska","family":"von der Helm","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annabel","family":"Fenwick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Reuter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Adolf-Lisitano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgar","family":"Mayr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"F\u00f6rch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,12,31]]},"reference":[{"issue":"11","key":"1847_CR1","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1302\/0301-620X.88B11.17634","volume":"88","author":"R Ekholm","year":"2006","unstructured":"Ekholm R, et al. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Jt Surg Br. 2006;88(11):1469\u201373.","journal-title":"J Bone Jt Surg Br"},{"key":"1847_CR2","first-page":"141","volume":"11","author":"SM Hosseini Khameneh","year":"2019","unstructured":"Hosseini Khameneh SM, et al. Humeral shaft fracture: a randomized controlled trial of nonoperative versus operative management (plate fixation). Orthop Res Rev. 2019;11:141\u20137.","journal-title":"Orthop Res Rev"},{"issue":"2","key":"1847_CR3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.rbo.2017.03.018","volume":"53","author":"FF Goncalves","year":"2018","unstructured":"Goncalves FF, et al. Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods. Rev Bras Ortop. 2018;53(2):136\u201341.","journal-title":"Rev Bras Ortop"},{"issue":"2","key":"1847_CR4","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s12306-017-0468-x","volume":"101","author":"G Campochiaro","year":"2017","unstructured":"Campochiaro G, et al. Humeral shaft non-union after intramedullary nailing. Musculoskelet Surg. 2017;101(2):189\u201393.","journal-title":"Musculoskelet Surg"},{"issue":"Suppl 2","key":"1847_CR5","doi-asserted-by":"publisher","first-page":"S75","DOI":"10.1016\/j.injury.2019.01.050","volume":"50","author":"G Toro","year":"2019","unstructured":"Toro G, et al. Humeral shaft non-union in the elderly: results with cortical graft plus stem cells. Injury. 2019;50(Suppl 2):S75\u20139.","journal-title":"Injury"},{"issue":"5","key":"1847_CR6","doi-asserted-by":"publisher","first-page":"596","DOI":"10.2106\/00004623-197759050-00004","volume":"59","author":"A Sarmiento","year":"1977","unstructured":"Sarmiento A, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Jt Surg Am. 1977;59(5):596\u2013601.","journal-title":"J Bone Jt Surg Am"},{"issue":"3","key":"1847_CR7","doi-asserted-by":"publisher","first-page":"e26271","DOI":"10.5812\/traumamon.26271v2","volume":"20","author":"AA Esmailiejah","year":"2015","unstructured":"Esmailiejah AA, et al. Treatment of humeral shaft fractures: minimally invasive plate osteosynthesis versus open reduction and internal fixation. Trauma Mon. 2015;20(3):e26271.","journal-title":"Trauma Mon"},{"issue":"9","key":"1847_CR8","doi-asserted-by":"publisher","first-page":"e825","DOI":"10.3928\/01477447-20150902-62","volume":"38","author":"Y Fan","year":"2015","unstructured":"Fan Y, et al. Management of humeral shaft fractures with intramedullary interlocking nail versus locking compression plate. Orthopedics. 2015;38(9):e825\u20139.","journal-title":"Orthopedics"},{"issue":"3","key":"1847_CR9","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.jse.2012.06.007","volume":"22","author":"H Ouyang","year":"2013","unstructured":"Ouyang H, et al. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elb Surg. 2013;22(3):387\u201395.","journal-title":"J Shoulder Elb Surg"},{"key":"1847_CR10","doi-asserted-by":"publisher","unstructured":"Sandriesser S, et al. Supplemental cerclage wiring in angle stable plate fixation of distal tibial spiral fractures enables immediate post-operative full weight-bearing: a biomechanical analysis. Eur J Trauma Emerg Surg. 2020. https:\/\/doi.org\/10.1007\/s00068-020-01503-0. Epub ahead of\nprint. PMID: 32989509.","DOI":"10.1007\/s00068-020-01503-0"},{"key":"1847_CR11","doi-asserted-by":"publisher","unstructured":"F\u00f6rch S, et al. Impairment of the blood supply by cerclages: myth or reality?: an overview of the experimental study situation. Unfallchirurg. 2020;124(3):231\u2013240. German. https:\/\/doi.org\/10.1007\/s00113-020-00847-x. PMID: 32813053; PMCID: PMC7921058.","DOI":"10.1007\/s00113-020-00847-x"},{"key":"1847_CR12","doi-asserted-by":"publisher","unstructured":"von der Helm F, et al. Compromising due to additive cerclages: can surgical treatment of humeral shaft fractures cause damage to the radial nerve?. Unfallchirurg. 2021. https:\/\/doi.org\/10.1007\/s00113-021-00995-8. Epub ahead of print. PMID: 33763738.","DOI":"10.1007\/s00113-021-00995-8"},{"issue":"Suppl 1","key":"1847_CR13","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","volume":"32","author":"EG Meinberg","year":"2018","unstructured":"Meinberg EG, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1\u2013170.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"1847_CR14","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.jse.2014.05.009","volume":"24","author":"E Ali","year":"2015","unstructured":"Ali E, et al. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elb Surg. 2015;24(2):210\u20134.","journal-title":"J Shoulder Elb Surg"},{"key":"1847_CR15","doi-asserted-by":"publisher","unstructured":"Denard Jr A, et al. Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. 2010;33(8).  https:\/\/doi.org\/10.3928\/01477447-20100625-16. PMID: 20704103.","DOI":"10.3928\/01477447-20100625-16"},{"issue":"3","key":"1847_CR16","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s00264-006-0200-1","volume":"31","author":"M Changulani","year":"2006","unstructured":"Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop. 2006;31(3):391\u20135.","journal-title":"Int Orthop"},{"issue":"2","key":"1847_CR17","doi-asserted-by":"publisher","first-page":"97","DOI":"10.5455\/medarh.2017.71.97-102","volume":"71","author":"M Bisaccia","year":"2017","unstructured":"Bisaccia M, et al. Comparison of plate, nail and external fixation in the management of diaphyseal fractures of the humerus. Med Arch. 2017;71(2):97\u2013102.","journal-title":"Med Arch"},{"issue":"5","key":"1847_CR18","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1007\/s001130050279","volume":"101","author":"J Blum","year":"1998","unstructured":"Blum J, et al. Retrograde nailing of humerus shaft fractures with the unreamed humerus nail. An international multicenter study. Unfallchirurg. 1998;101(5):342\u201352.","journal-title":"Unfallchirurg"},{"issue":"3","key":"1847_CR19","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s11751-014-0204-0","volume":"9","author":"MG Wali","year":"2014","unstructured":"Wali MG, et al. Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study. Strateg Trauma Limb Reconstr. 2014;9(3):133\u201340.","journal-title":"Strateg Trauma Limb Reconstr"},{"issue":"11","key":"1847_CR20","doi-asserted-by":"publisher","first-page":"e162775","DOI":"10.1001\/jamasurg.2016.2775","volume":"151","author":"R Zura","year":"2016","unstructured":"Zura R, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016;151(11):e162775.","journal-title":"JAMA Surg"},{"issue":"Suppl 2","key":"1847_CR21","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s12306-017-0509-5","volume":"101","author":"A Maresca","year":"2017","unstructured":"Maresca A, et al. Why a surgically treated humeral shaft fracture became a nonunion: review of 11 years in two trauma centers. Musculoskelet Surg. 2017;101(Suppl 2):105\u201312.","journal-title":"Musculoskelet Surg"},{"issue":"1","key":"1847_CR22","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s13018-018-0800-7","volume":"13","author":"RM Natoli","year":"2018","unstructured":"Natoli RM, et al. Alcohol exposure decreases osteopontin expression during fracture healing and osteopontin-mediated mesenchymal stem cell migration in vitro. J Orthop Surg Res. 2018;13(1):101. https:\/\/doi.org\/10.1186\/s13018-018-0800-7. PMID:\n29699560; PMCID: PMC5921778.","journal-title":"J Orthop Surg Res"},{"issue":"8","key":"1847_CR23","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1016\/j.injury.2019.06.014","volume":"50","author":"JG Putnam","year":"2019","unstructured":"Putnam JG, et al. Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures. Injury. 2019;50(8):1460\u20133.","journal-title":"Injury"},{"issue":"17","key":"1847_CR24","doi-asserted-by":"publisher","first-page":"e19858","DOI":"10.1097\/MD.0000000000019858","volume":"99","author":"\u015e Yi\u011fit","year":"2020","unstructured":"Yi\u011fit \u015e. What should be the timing of surgical treatment of humeral shaft fractures? Medicine. 2020;99(17):e19858.","journal-title":"Medicine"},{"issue":"2","key":"1847_CR25","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1007\/s00068-017-0775-9","volume":"44","author":"TR Schwab","year":"2018","unstructured":"Schwab TR, et al. Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome. Eur J Trauma Emerg Surg. 2018;44(2):235\u201343.","journal-title":"Eur J Trauma Emerg Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01847-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-021-01847-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-021-01847-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,8]],"date-time":"2022-08-08T14:07:42Z","timestamp":1659967662000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-021-01847-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,31]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,8]]}},"alternative-id":["1847"],"URL":"https:\/\/doi.org\/10.1007\/s00068-021-01847-1","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,31]]},"assertion":[{"value":"28 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Franziska von der Helm, Annabel Fenwick, Jan Reuter, Leonard Adolf-Lisitano, Edgar Mayr, and Stefan F\u00f6rch declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}