Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

Zavras, Athan G.; Monahan, Kevin T.; Winek, Nathan C.; Pan, Tommy; Altman, Gregory T.; Altman, Daniel T.; Westrick, Edward

doi:10.2106/jbjs.22.01374

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…Humeral shaft fractures have historically been predominantly treated nonoperatively, but recent studies have suggested that nonunion rates are much higher than previously reported. A meta-analysis of 21 RCTs compared functional bracing with various operative fixation techniques 6 . Bracing had a significantly higher rate of nonunion (17.4%) than open reduction and internal fixation (ORIF) (5.2%), minimally invasive plate osteosynthesis (0.6%), and antegrade nailing (6.1%).…”

Section: Humeral Shaft and Elbowmentioning

confidence: 99%

What’s New in Orthopaedic Trauma

Chen,

Patterson

2024

Journal of Bone and Joint Surgery

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The treatment of displaced proximal humeral fractures remains controversial. An updated systematic review and meta-analysis compared conservative treatment and surgical treatment (plating, nailing, or arthroplasty) of displaced fractures in adults ‡50 years of age 1 . Twenty-two trials (1,814 patients) were included, and no meaningful differences in clinical outcome or range of motion were identified. Complications were 3.3 times higher in the surgical treatment group. However, the study did not differentiate among 2-part, 3-part, or 4-part fractures. It also included both randomized controlled trials (RCTs) and comparative observational studies, which may have been impacted by a high risk of bias.Surgical treatment may be warranted in select populations. The lack of restoration of the medial column has been suggested to contribute to fixation failure. An RCT compared clinical and radiographic outcomes following locking plate fixation with (39 patients) or without (41 patients) a fibular allograft for proximal humeral fractures with medial column comminution 2 . There was no clinically important improvement in the Disabilities of the Arm, Shoulder and Hand (DASH) score or improvement in postoperative radiographs with addition of fibular allograft augmentation at 1 year.In certain fractures in the elderly population, reverse shoulder arthroplasty is chosen for definitive treatment. However, the ideal timing for a surgical procedure is unclear. A systematic review and meta-analysis compared outcomes following acute and delayed reverse shoulder arthroplasty ( ‡4 weeks after the injury) in patients ‡65 years of age 3 . Sixteen studies were included, and the overall complication rate was higher in the delayed group (18.5%) compared with the acute group (11.7%). Patients who underwent acute reverse shoulder arthroplasty also had better range-of-motion measurements as well as better American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. The results suggest that the surgical timing of arthroplasty for fracture treatment is important.High-grade injuries to the acromioclavicular joint may warrant fixation. Controversy remains with regard to the best type of fixation. A systematic review compared outcomes following suture button fixation (363 patients) and hook plate fixation (432 patients) for acute injuries (£21 days) 4 . Fourteen comparative studies were included, with suture Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I34).

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Section: Humeral Shaft and Elbowmentioning

confidence: 99%

What’s New in Orthopaedic Trauma

Chen,

Patterson

2024

Journal of Bone and Joint Surgery

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Non-Operative Treatment of Humeral Shaft Fractures with Immediate Functional Bracing versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study

Muhammad,

Foster,

Griffin

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To compare radiographic and clinical outcomes in non-operative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. METHODS: Design: Retrospective cohort study Setting: Academic Level 1 Trauma Center Patient Selection Criteria: Patients with closed humeral shaft fractures managed non-operatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months follow-up were excluded. Outcome Measures and Comparisons: The primary outcome was coronal and sagittal radiographic alignment assessed at final follow-up. Secondary outcomes included rate of failure of non-operative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. RESULTS: Ninety-seven patients were managed non-operatively with delayed FB (n=58) or immediate FB (n=39). Overall, the mean age was 49.9 years (range 18-94), and 64 (66%) patients were female. The immediate FB group had less smokers (p=0.003) and lower incidence of radial nerve palsy (p=0.025), with more proximal third humeral shaft fractures (p=0.001). There were no other significant differences in demographic or clinical characteristics (p>0.05). There were no significant differences in coronal (p=0.144) or sagittal (p=0.763) radiographic alignment between groups. In total, 33 (34.0%) humeral shaft fractures failed non-operative management, with 11 (28.2%) in the immediate FB group, and 22 (37.9%) in the delayed FB group (p=0.322). There were no significant differences in fracture union (p=0.074) or skin complications (p=0.259) between groups. CONCLUSIONS: This study demonstrated that non-operative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with coaptation splinting followed by delayed functional bracing. Future prospective studies assessing patient reported outcomes (PROs) will further guide clinical decision making. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Rehabilitation Features for Patients with Diaphyseal Humerus Fractures During Conservative Treatment

Kononenko,

Pelypenko,

Kovalov

et al. 2023

Acta Balneol

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Aim: Determination of the key criteria for selecting the optimal physical rehabilitation scheme depending on the chosen method of conservative treatment. Materials and Methods: The study involved 53 patients with diaphyseal humerus fractures. In all cases, conservative functional treatment methods have been applied. Results: Based on the applied methods of conservative treatment, four clinical groups for medical rehabilitation have been identified: A, B, C, D, each containing 2 subgroups, depending on the relationship between the bone fragments and the sites of muscle attachment in the diaphyseal segment of the humerus. Subgroup “1” involved patients with diaphyseal humerus fractures, where the fragments serve as the sites of attachment for muscles. Subgroups “2” encompassed cases with fractures in the specified area, where the fragments do not serve as the sites of muscle insertion. The assessment of the functional activity of the elbow and shoulder joints was performed using the MEPS and CMS scales, respectively. Conclusions: The anatomical and topographical features of the muscle component are crucial for selecting the optimal tactics for conducting rehabilitation measures.

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Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

Cited by 3 publications

References 45 publications

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Non-Operative Treatment of Humeral Shaft Fractures with Immediate Functional Bracing versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study

Rehabilitation Features for Patients with Diaphyseal Humerus Fractures During Conservative Treatment

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