To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention.
Multicenter, retrospective analysis.
Nine Level 1 trauma centers across the United States.
A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions.
Main outcome measurements:
Conversion to surgery.
A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion.
This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures.
Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The anterior intrapelvic approach can be used for the reduction and fixation of displaced fractures of the acetabulum. Reduction techniques and options for placement of fixation deviate to some degree from those used with the traditional ilioinguinal approach secondary to the surgeon's perspective and available vectors. Here, we present several techniques for the application of reduction clamps, reduction techniques, and fixation options for the posterior column in displaced fractures of the acetabulum treated through the anterior intrapelvic approach.
Surgical treatment of metastatic disease to bone continues to evolve. Advances have been made in diagnosis, improved surgical outcomes, and minimally invasive procedures. Improved prediction of risk for bone fracture continues to evolve with CT-based techniques including structural rigidity analysis and finite element modeling. Improved surgical outcomes have been seen in treatment of proximal femoral pathologic lesions and fractures with the pendulum swinging toward more use of endoprosthetic devices over internal fixation, humeral lesions with a wide variety of techniques, and acetabular lesions with the use of tantalum acetabular cups and augments. Minimally invasive techniques including osteoplasty, radiofrequency ablation, cryoablation, and high-intensity ultrasound offer alternatives to open surgical treatment. Despite this evolution, the goals of treatment remain the same: pain relief, immediate stability, local disease control, and maintenance or restoration of function. Keywords Metastatic bone disease Á Pathologic fracture Á Structural analysis Á Augmented acetabular reconstruction Á Radiofrequency ablation Á Cryoablation Á High-intensity focused ultrasound This article is part of the Topical Collection on Ortho-oncology.
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