OTA 1997 Posters - Humerus Fractures

Effect of Immediate Weightbearing on Plated Fractures of the Humeral Shaft

Philip R. Wolinsky, MD, Ed Tingstad, MD, Yu Shyr, PhD, Kenneth D. Johnson, MD

VUMC, Nashville, Tennessee, USA

Purpose: To evaluate the effect of immediate weightbearing on fractures of the humeral shaft treated with internal fixation.

Methods: A database search was carried out to identify fractures of the humeral shaft that had been treated with open reduction and internal fixation at our institution during the years 1986 to 1995. Patient charts and radiographs were then reviewed. To be included in the study, patients had to have follow-up of at least one year or have documented healing of their fracture if the follow-up was less than one year. Appropriate statistical analysis was carried out. Statistical significance was defined as a p <0.05.

Results: One hundred eleven fractures were identified. Eighty-three fractures in 82 patients met the inclusion criteria. Ninety-one percent of the fractures occurred as the result of a motor vehicle or motorcycle accident. The average age was 32.8 years (range 13-79), and the male to female ratio was 44:38. Follow-up averaged 379 days (range 40-326). 86% of the patients had additional injuries. Fifty-nine fractures were closed, and 24 were open. A preoperative radial nerve palsy was present in 34% of the fractures. There was no association between fracture location, pattern, or comminution and presence of a radial nerve palsy. One iatrogenic nerve palsy occurred, and resolved 3 weeks postoperatively.

Seventy-eight fractures (94%) healed after the initial operation. Five fractures (6%) required a second operation to achieve union. One closed fracture (1.2%) developed an infection 9 months postoperatively. No open fracture developed an infection. All fractures healed with less than 10° of varus/valgus or procervatum/recurvatum. The decision to allow weightbearing through the injured humerus using a platform crutch or walker was based on the weightbearing status of the lower extremities and not on the fracture pattern of the humerus fracture. Fifty-two percent of the fractures were allowed full weight bearing, 40% were kept non-weightbearing, and 8% were allowed to transfer. Statistical analysis revealed no difference in patient or fracture demographics between the groups, including fracture location, pattern, and comminution or number of screws placed proximal or distal to the fracture site. Of the 5 fractures that required a second procedure to gain union, 2 were in the non-weightbearing group and 3 were in the full weightbearing group. The difference is not significant.

Discussion and Conclusion: Compression plating of fractures of the humeral shaft is a safe and effective procedure resulting in a high union rate, and a low infection and iatrogenic nerve injury rate. Immediate weightbearing through the plated humerus is safe and does not result in an increased rate of nonunion or need for reoperation.