No Differences in Clinical, Functional, or Patient-Reported Outcomes Following Trial of Non-operative Management Prior to Open Reduction and Internal Fixation of Humeral Shaft Fractures

• Published in: Journal of orthopaedic trauma
• Main Authors: Patel, Urvi J, Holloway, Melissa R, Carroll, Thomas J, Soin, Sandeep P, Ketz, John P
• Format: Journal Article
• Language: English
• Published: United States 07-03-2024
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/BOT.0000000000002796

To test the hypothesis that primary osteosynthesis of humeral shaft fractures may lead to more favorable clinical, functional, and patient-reported outcomes than fixation following a trial of nonoperative management.
Retrospective Cohort Review.
Academic Level I Trauma Center.
Adult patients who presented with humeral shaft fractures, and ultimately underwent open reduction and internal fixation (ORIF) from 05/2011 to 05/2021. Patients who underwent ORIF within 2 weeks of injury were grouped into the primary osteosynthesis cohort, and patients who underwent ORIF >4 weeks from date of injury were grouped into the trial of nonoperative cohort.
Post-operative complications, elbow arc of motion, time to radiographic union, and patient-reported outcomes were investigated and compared between the primary osteosynthesis and trial of nonoperative management cohorts.Results: 127 patients fit the study criteria, 84 underwent primary osteosynthesis and 43 trialed initial non-operative treatment. No differences were found in patient demographics between the primary osteosynthesis and trial of non-operative management cohorts, including age (53±19 vs. 57±18; p=0.25), sex (39% vs. 44% male, 61% vs. 56% female; p=0.70), and BMI (30±6 vs. 32±9; p=0.38) . The average time to operative intervention in the primary osteosynthesis group was 4 days (0-14 days), and 105 days (28-332 days) in the trial of non-operative treatment group (p<0.01). No differences were found with regards to intra-operative blood loss, total operative time, time to radiographic union (determined using the RUSHu scoring system), or overall complication rates, including primary and secondary radial nerve injuries (P=0.23 and 0.86, respectively). Patients reported similar PROMIS Pain Interference (PI) (P=0.73), Depression (D) (P=0.99), and Physical Function (PF) (P=0.66) scores at their 6-month post-surgical follow up visits.
Patients who attempted a trial of non-operative management for humeral shaft fractures prior to open reduction and internal fixation had similar clinical, functional, and patient reported outcomes as those who underwent primary osteosynthesis.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.