Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients

Abstract

BackgroundAlthough the non-operative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear.ObjectiveTo compare the outcomes of operative and non-operative treatment of traumatic closed humeral midshaft fractures in adult patients.MethodsA multicentre prospective comparative cohort study across 20 centres was conducted. Patients with AO type 12 A2, A3 and B2 fractures were treated with a functional brace or a retrograde-inserted unreamed humeral nail. Follow-up measurements were taken at 6, 12 and 52 weeks after the injury. The primary outcome was fracture healing after 1 year. Secondary outcomes included sub-items of the Constant score, general patient satisfaction, complications and cost-effectiveness parameters. Functions of the uninjured extremity were used as reference parameters. Intention-to-treat analysis was applied with the use of t-tests, Fisher’s exact tests, Mann–Whitney U-tests and adjusted analysis of variance (ANOVA).ResultsForty-seven patients were included. The patient sample consisted of 23 women and 24 men, with a mean age of 52.7 years (range 17–86 years). Of the 47 cases, 14 were treated non-operatively and 33 operatively. The follow-up rate at 1 year was 81%. After 1 year, 11 fractures (100%) healed in the non-operative group and at least 24 fractures (≥89%) healed in the operative group [1 non-union patient (4%) and no data for 2 patients (7%)]. There were no significant differences in pain, range of motion (ROM) of the shoulder and elbow, and return to work after 6 weeks, 12 weeks and 1 year. Although operatively treated patients showed significantly greater shoulder abduction strength (p = 0.036), elbow flexion strength (p = 0.021), functional hand positioning (p = 0.008) and return to recreational activities (p = 0.043) after 6 weeks, no statistically significant differences existed in any outcome measure at the 1-year follow-up.ConclusionsOur findings indicate that the non-operative management of humeral midshaft fractures can be expected to have similar functional outcomes and patient satisfaction at 1 year, despite an early benefit to operative treatment. If no radiological evidence of fracture healing exists in non-operatively treated patients during early follow-up, a switch to surgical treatment results in good functional outcomes and patient satisfaction.

Comparison of Initial Nonoperative and Operative Management of Radial Nerve Palsy Associated With Acute Humeral Shaft Fractures

“…6 The current findings are also consistent with those reported in the only prospec- cme ARTICLE tive study published to date, which compared outcomes following management of humeral midshaft fractures. 17 Although the patients treated operatively in that prospective study had more favorable outcomes in terms of shoulder abduction strength, elbow flexion strength, functional hand positioning, and return to recreational activities after 6 weeks, no statistically significant differences were found between the 2 management approaches for any of the outcome measures at 1-year follow-up. 17 Recovery from radial nerve palsy may be affected by several factors, includ- Figure 4: Effect of operative treatment on complaints of treatment in fixed effects model.…”

“…17 Although the patients treated operatively in that prospective study had more favorable outcomes in terms of shoulder abduction strength, elbow flexion strength, functional hand positioning, and return to recreational activities after 6 weeks, no statistically significant differences were found between the 2 management approaches for any of the outcome measures at 1-year follow-up. 17 Recovery from radial nerve palsy may be affected by several factors, includ- Figure 4: Effect of operative treatment on complaints of treatment in fixed effects model. Fixed-effects (Mantel-Haenszel) meta-analysis included the findings from 6 studies.…”

“…Hence, 9 articles were included in the systematic review and meta-analyses. [10][11][12][13][14][15][16][17][18] Study Characteristics Table 1 summarizes the characteristics of all studies included in the meta-analyses. The studies were published between 1972 and 2011 and included 1 prospective study 17 and 8 retrospective studies.…”

“…[10][11][12][13][14][15][16][17][18] Study Characteristics Table 1 summarizes the characteristics of all studies included in the meta-analyses. The studies were published between 1972 and 2011 and included 1 prospective study 17 and 8 retrospective studies. [10][11][12][13][14][15][16][17][18] No randomized, controlled trials were included in the analyses.…”

“…The studies were published between 1972 and 2011 and included 1 prospective study 17 and 8 retrospective studies. [10][11][12][13][14][15][16][17][18] No randomized, controlled trials were included in the analyses. The studies included a total of 620 patients: 239 who received nonoperative treatment and 381 who received operative treatment.…”