Session XII - Upper Extremity

Sat., 10/7/06 Upper Extremity, Paper #70, 3:42 pm

Outcome after Nonoperatively Treated Humeral Shaft Fractures

Radford Ekholm, MD (n); Jan Tidermark, MD, PhD (n);
Hans Törnkvist, MD, PhD (n); Johanna Adami, MD, PhD (n);
Sari Ponzer, MD, PhD (n);
Karolinska Institutet at Stockholm Söder Hospital, Stockholm, Sweden

Purpose: The purpose of this study was to investigate the outcome after an isolated humeral shaft fracture primarily treated nonoperatively, ie fracture brace treatment.

Methods: In a cohort study, we performed a retrospective assessment of clinical and radiographic healing and a prospective assessment of functional outcome and health-related quality of life (HRQoL). 78 patients (female, n = 45), mean age 58 years (range, 16-91) with an isolated humeral shaft fracture primarily nonoperatively treated were assessed. The main outcome measurements were fracture healing, need for revision surgery, Short Musculoskeletal Functional Assessment (SMFA), HRQoL according to the SF-36, and patient-reported recovery.

Results: 90% of the fractures healed after nonoperative treatment and nearly 90% of the nonunions healed after revision surgery. There was a trend toward more frequent nonunions in simple fractures, ie type A according to the OTA classification (P = 0.08). The nonunion rate in type A fractures located in the proximal and middle part of the shaft was approximately 20%. Nearly 50% of the patients reported full recovery after successful nonoperative treatment but none of the patients with a healed nonunion after revision surgery did (P <0.05). The SMFA scores for arm/hand function were acceptable for the patients who healed after the primary fracture brace treatment, but the values were worse for those with a healed nonunion after revision surgery. The SF-36 scores were generally slightly lower compared to a Swedish reference population.

Conclusion/Significance: The study confirms the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture brace treatment. However, in simple (type A) fractures, the nonunion rate seems to be higher and patients with healed nonunions after revision surgery reported worse functional outcomes. Based on these findings, it seems reasonable to explore the use of an alternative treatment, ie plate fixation, for selected fracture types.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.