Session IX - Upper Extremity

Sat., 10/12/13 Upper Extremity, PAPER #98, 2:32 pm OTA 2013

Functional Outcome Scores of Humeral Shaft Fractures in Patients TreatedNonoperatively Compared to Those Treated Surgically

Edward Shields, MD; Michael Maceroli, MD; Leigh Sundem; Sean Childs; Adrian Hadiono; Catherine Humphrey, MD; Jonathan Gross, MD; John Ketz, MD; John Gorczyca, MD;
University of Rochester, Strong Memorial Hospital, Rochester, New York, USA

Purpose: Most studies of humeral shaft fractures report fracture angulation and shoulder range of motion, but not functional outcomes. This study used validated functional outcome measures to assess patients following nonoperative and surgical management of humeral shaft fractures. Our hypothesis is that patients treated surgically will have less disability and better shoulder function.

Methods: 240 patients treated between 2004 and 2011 were retrospectively identified with billing codes. Patients from this cohort were recruited by telephone to obtain the following functional outcome scores: Disabilities of the Arm, Shoulder and Hand (DASH), the Simple Shoulder Test (SST), and general health questionnaire Short Form-12 (SF-12). Patients were asked to rate their pain during the immediate 3-week period following surgery or splinting (scale 1-10), whether or not they would undergo the same treatment again, and if they were pleased with the cosmetic appearance of their arm. Patient chart reviews were conducted to obtain basic demographic data. Data were analyzed using two-tailed Student T tests, Mann-Whitney U test, or χ2, and the data are present as the mean ± the standard error of the mean (SEM).

Results: 66 patients were recruited with complete data sets. Number of months from treatment rendered to interview date (surgical 44.6 ± 4.9 vs nonoperative 45.6 ± 5.7; P = 0.89) and average age (surgical 48.9 ± 3.2 vs nonoperative 43.5.8 ± 4.7; P = 0.32) did not differ between treatment groups. The DASH scores were higher in patients treated surgically (DASH 26.8 ± 3.7; n = 38) than in patients treated nonoperatively (DASH 12.9 ± 3.2; P <0.05; n = 29). Average functional shoulder scores were lower in patients treated surgically (SST 8.00 ± 0.6) than in patients treated without surgery (SST 9.93 ± 0.5; P <0.05). The SF-12 physical component summary (PCS) was higher in the nonoperative group (49.6 ± 2.3) compared to the surgical group (39.4 ± 1.3; P <0.05). The mental component summary (MCS) did not differ between the groups (surgical MCS 51.8 ± 1.8; nonoperative MCS 53.2 ± 1.6; P = 0.55). 79% of surgical patients would undergo surgery again, while 66% of the nonoperative group would repeat the same treatment (P = 0.19). Self-reported pain scores in the 3 weeks following treatment were 5.9 ± 0.5 for surgery and 6.4 ± 0.4 for nonoperative treatment (P = 0.51). Of the patients surveyed, 73% of the surgical group were happy with the cosmetic appearance of the arm, and 66% were pleased in the nonoperative group (P = 0.51).

Conclusion: Patients with humeral shaft fractures that meet surgical criteria and undergo surgical fixation have less shoulder function, worse overall physical health, and more upper extremity disability compared to patients who can be managed nonoperatively. Both patient populations have similar mental health outcomes, posttreatment pain, and cosmetic appeal. The difference in outcomes suggests that humeral shaft fractures meeting surgical criteria are more severe and result in decreased long-term upper extremity function compared to injuries that do not meet these criteria.

Alphabetical Disclosure Listing

• 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.