Jill G Putnam1, Lauren Nowak2, David Sanders3, Melanie MacNevin4, Abdel-Rahman Lawendy5, Clifford Jones6, Michael McKee7, Emil Schemitsch8. 1. Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States. Electronic address: Jill.Goodwin@BannerHealth.com. 2. University of Toronto, Toronto, Ontario, Canada. Electronic address: Lauren.Nowak@mail.utoronto.ca. 3. London Health Sciences Centre, London, Ontario, Canada. Electronic address: David.Sanders@lhsc.on.ca. 4. Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States; London Health Sciences Centre, London, Ontario, Canada. Electronic address: Melanie.Macnevin@lhsc.on.ca. 5. London Health Sciences Centre, London, Ontario, Canada. Electronic address: AbdelRahman.Lawendy@lhsc.on.ca. 6. Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States. Electronic address: Clifford.Jones@thecoreinstitute.com. 7. Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, 1320 N 10th Street, Suite A, Phoenix, AZ, 85006, United States. Electronic address: McKeeM@smh.ca. 8. London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada. Electronic address: Emil.Schemitsch@lhsc.on.ca.
Abstract
INTRODUCTION: This study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures. PATIENTS AND METHODS: Patients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005-2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex. RESULTS: Plate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/-62 min vs. 102 +/-54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26-7.85). CONCLUSION: Patients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures.
INTRODUCTION: This study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures. PATIENTS AND METHODS: Patients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005-2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex. RESULTS: Plate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/-62 min vs. 102 +/-54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26-7.85). CONCLUSION:Patients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures.
Authors: Maria Anna Smolle; Sandra Bösmüller; Paul Puchwein; Martin Ornig; Andreas Leithner; Franz-Josef Seibert Journal: EFORT Open Rev Date: 2022-01-11
Authors: Franziska von der Helm; Annabel Fenwick; Jan Reuter; Leonard Adolf-Lisitano; Edgar Mayr; Stefan Förch Journal: Eur J Trauma Emerg Surg Date: 2021-12-31 Impact factor: 2.374