Rafael Serrano1, Hassan R Mir1, Henry C Sagi2, Daniel S Horwitz3, Amrut Borade, John E Tidwell, John P Ketz4, Brian J Kistler5, Jonathan H Quade6, Michael J Beebe7, Brigham K Au8, Roy W Sanders1, Anjan R Shah1. 1. Orthopaedic Trauma Service, Florida Orthopaedic Institute and University of South Florida, Tampa, FL. 2. Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH. 3. Department of Orthopaedics, Geisinger Medical Center, Danville, PA. 4. Department of Orthopaedics, University of Rochester, Rochester, NY. 5. Department of Orthopedics, Upstate Orthopedics, Syracuse, NY. 6. Division of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL. 7. Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN; and. 8. Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX.
Abstract
OBJECTIVES: To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention. DESIGN: Multicenter, retrospective analysis. SETTING: Nine Level 1 trauma centers across the United States. PATIENTS: A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions. INTERVENTION: Functional brace. MAIN OUTCOME MEASUREMENTS: Conversion to surgery. RESULTS: A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion. CONCLUSIONS: This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention. DESIGN: Multicenter, retrospective analysis. SETTING: Nine Level 1 trauma centers across the United States. PATIENTS: A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions. INTERVENTION: Functional brace. MAIN OUTCOME MEASUREMENTS: Conversion to surgery. RESULTS: A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion. CONCLUSIONS: This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Lasse Rämö; Bakir O Sumrein; Vesa Lepola; Tuomas Lähdeoja; Jonas Ranstam; Mika Paavola; Teppo Järvinen; Simo Taimela Journal: JAMA Date: 2020-05-12 Impact factor: 56.272
Authors: Lasse Rämö; Mika Paavola; Bakir O Sumrein; Vesa Lepola; Tuomas Lähdeoja; Jonas Ranstam; Teppo L N Järvinen; Simo Taimela Journal: JAMA Surg Date: 2021-04-14 Impact factor: 14.766