Fri., 10/9/09 Upper Extremity, Paper #49, 11:45 am OTA-2009
Operative versus Nonoperative Treatment of Humeral Shaft Fractures: A Retrospective Review of 213 Patients from Two Level I Trauma Centers
Southeastern Fracture Consortium;
Michael C. Tucker, MD1 (10-Southeastern Fracture Consortium research grant);
William T. Obremskey, MD2 (5A-Medtronic, Osteogenix; 7-Synthes); Mark Floyd, BS3 (n);
Anthony Denard, BS2 (n);
1Palmetto Health Richland/USC, Columbia, South Carolina, USA;
2Vanderbilt University, Nashville, Tennessee, USA;
3Medical College of Georgia, Augusta, Georgia, USA
Purpose: Nonoperative management of closed humeral shaft fractures (OTA-12) has long been considered the treatment of choice for the majority of these injuries. Operative management of closed humeral shaft fractures using plate and screw fixation has been effectively demonstrated as an alternative treatment option. We intend to retrospectively compare the demographics along with rates of infection, nonunion, malunion, and iatrogenic radial nerve palsy as well as clinical range of motion to a large number of patients with closed humeral fractures to assess if classic teaching of nonoperative care is still applicable.
Methods: All patients treated for a closed humeral shaft fracture (OTA-12) at 2 Level 1 trauma centers between 2001 and 2005 were retrospectively identified by diagnosis and treatment codes after IRB approval. Various demographic and comorbidity data were also reviewed. Complication rates including infection, nonunion, malunion, clinical range of motion, and iatrogenic radial nerve palsy were evaluated and compared for patients treated nonoperatively versus those managed with plate and screw fixation.
Results: 213 adult humeral shaft fractures meeting the inclusion criteria were identified. Plate and screw fixation was used in 150 patients, with 63 patients receiving nonoperative management. Of 213 patients, 13 (6%) were lost to follow-up. Operative approaches included anterior-lateral (83%) and posterior (17%). Implants included traditional, nonlocking 4.5-mm plates (narrow, 34%; broad, 4%) and locking-4.5 mm plates (62%). No significant differences related to age, gender, or occurrence of diabetes or cancer were noted between the groups. Tobacco use was significantly different (P = 0.0003), with operatively treated patients demonstrating a much higher usage rate (32%) than those treated nonoperatively (4%). Occurrence of malunion (13% vs 1%; P = 0.0011) and nonunion (23% vs 9%; P = 0.0128) was statistically significant and more common in the nonoperatively treated group. Infection occurred in 1 patient (low-energy gunshot wound) treated nonoperatively (1.5%) and 7 patients treated operatively (5%). Iatrogenic radial nerve palsy was reported in 12 patients (12/150, 8%) treated acutely with operative intervention. All 12 demonstrated complete or partial recovery. No difference in time to union or ultimate range of motion was found between the 2 groups.
Conclusion: Closed treatment of humerus fractures had a significantly higher risk of nonunion (23% vs 9%) and malunion (13% vs 1%) than operative treatment, with a lower risk of transient nerve palsy (0% vs 8%) and deep infection (1.5% vs 5%). Surgeons can use these recent data from Level 1 centers to advise patients on treatment decisions.
• 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. Δ OTA Grant