Functional results of braced humeral diaphyseal fractures; why do 38% lose external rotation of the shoulder?

Fjalestad, Tore; Strømsøe, Knut; Salvesen, Petter; Rostad, Bjørg

doi:10.1007/s004020050465

Cited by 42 publications

(28 citation statements)

References 5 publications

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“…Most diaphyseal humeral fractures can be managed nonoperatively and good outcomes can be expected in most cases (Sarmiento and Latta 1999, Fjalestad et al 2000, Sarmiento and Latta 2007). However, operative treatment is indicated under a number of circumstances including open fractures, associated neurovascular injury, proximal and distal articular extension of the fracture, and in patients with other multiple injuries (Pollock et al 1981, Bell et al 1985, Hegelmaier and von Aprath 1993, Brug et al 1994, Sarmiento et al 2002).…”

Section: Introductionmentioning

confidence: 99%

Plate fixation or intramedullary fixation of humeral shaft fractures

Heineman¹,

Poolman²,

Nork³

et al. 2010

Acta Orthopaedica

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BackgroundThe optimal approach to operative treatment of humeral shaft fractures remains debatable. Previously published trials have been limited in size and have been inconclusive regarding important patient outcome variables following treatment with either intramedullary nails or plates. We conducted a meta-analysis of available trials comparing treatment of humeral shaft fractures.Methods We performed a literature search from 1967 to November 2007 in the main medical search engines and selected 4 randomized trials that compared nails and plates in patients with humeral shaft fractures and that reported on complications due to surgery. We statistically pooled patient data using standard meta-analytic approaches. Our primary outcome was the total complication rate, comprised of all complications listed in the articles included. Secondary outcomes included non-union, infection, nerve palsy, and reoperation rate. Methodology was assessed using the CLEAR NPT.Results When pooling the data of the 4 trials (n = 203 patients), we did not find a statistically significant difference between implants in the rate of total complications, non-union, infection, nerve-palsy, or the need for reoperation. The studies included were small and had methodological limitations.Conclusions Our meta-analysis suggests stastistically insignificant differences between plates and nails in the treatment of humeral shaft fractures. Small sample sizes, study heterogeneity, and methodological limitations argue strongly for a definitive, large trial. We recommend that this trial should be a randomized controlled trial with appropriate allocation of patients and blinding of patients and care providers and outcome assessors, and that it should include patient-important outcomes.

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Section: Introductionmentioning

confidence: 99%

Plate fixation or intramedullary fixation of humeral shaft fractures

Heineman¹,

Poolman²,

Nork³

et al. 2010

Acta Orthopaedica

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“…First, it is a retrospective study based on the medical records from three different institutions. We were not able to evaluate all medical comorbidities (e.g., obesity and alcohol abuse 15,16 ) or the exact duration of functional bracing because of the limitations of the documentation. Second, we used the best initial radiographs, five of which were made prior to splint application and therefore might have differed in important ways from the radiographs obtained with the injured extremity in the splint.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Neuhaus

Menendez

Kurylo³

et al. 2014

Journal of Bone and Joint Surgery

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BACKGROUND: Recent studies have identified specific subsets of diaphyseal humeral fractures for which functional bracing is less effective. The present study tested the hypothesis that a gap between fracture fragments may be a risk factor (after accounting for other potential risk factors) for fracture instability six weeks after functional bracing of humeral shaft fractures. METHODS: We retrospectively identified seventy-nine adult patients (forty-six men, thirty-three women; forty-two fractures on the right side, thirty-seven fractures on the left), each with an acute, closed, AO type-A2 (oblique, 30°) or type-A3 (transverse, lt;30°) mid-diaphyseal humeral shaft fracture treated nonoperatively at three different level-I trauma centers from June 2004 to August 2011. The gap between the fracture fragments was measured on the first radiographs made after the affected upper extremity was placed in a brace. RESULTS: Sixty-three patients (80%) had documented healing of the fracture. Sixteen patients (20%) had motion at the fracture site and a persistent fracture line shown on radiographs six weeks or more after injury. In multivariable analysis, each millimeter of gap between the main fragments with the patient wearing the brace (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.1 to 1.7), smoking (OR = 5.8, 95% CI = 1.4 to 25), and female sex (OR = 5.3, 95% CI = 1.2 to 23) increased the risk of fracture instability six weeks after injury (R2 = 0.38, area under the receiver operating characteristic [ROC] curve = 0.81). CONCLUSIONS: The magnitude of the gap between the fracture fragments is an independent risk factor for fracture instability and the lack of a bridging callus six weeks after a diaphyseal humeral fracture. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…Treatment with functional bracing can lead to loss of some shoulder external rotation, flexion, and abduction in 10 % to 30 % of patients. Also, loss of elbow flexion and extension is impaired in less than 10 % of patients [6,15,16]. Sarmiento and colleagues have published a relatively large series of 620 patients with 97 % union rates and high satisfaction rates with functional bracing.…”

Section: Current Concepts In Nonoperative Versus Operative Interventionmentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

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Functional results of braced humeral diaphyseal fractures; why do 38% lose external rotation of the shoulder?

Cited by 42 publications

References 5 publications

Plate fixation or intramedullary fixation of humeral shaft fractures

Plate fixation or intramedullary fixation of humeral shaft fractures

Risk Factors for Fracture Mobility Six Weeks After Initiation of Brace Treatment of Mid-Diaphyseal Humeral Fractures

Humeral shaft fractures

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