Initial Displacement of Humeral Shaft Fractures Is Associated With Failure of Nonoperative Management
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved..
OBJECTIVES: To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management.
DESIGN: Retrospective cohort study.
SETTING: Urban level 1 trauma center.
PATIENTS/PARTICIPANTS: 106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively.
INTERVENTION: Functional bracing.
MAIN OUTCOME MEASUREMENTS: Failure of nonoperative management, defined as conversion to surgery, malunion, and delayed union/nonunion.
RESULTS: Nonoperative management failed in 33 (31%) of 106 included patients with 27 patients (25%) requiring surgery. On multivariate analysis, female sex [odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21], American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior-posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11 degrees (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, 1, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively.
CONCLUSIONS: Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cut-off values were established that may be used by surgeons to counsel patients with these injuries.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Journal of orthopaedic trauma - 37(2023), 5 vom: 01. Mai, Seite e200-e205 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Ye Joon [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 19.09.2023 Date Revised 19.09.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/BOT.0000000000002543 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352398396 |
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| 500 | |a Date Revised 19.09.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management | ||
| 520 | |a DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: Urban level 1 trauma center | ||
| 520 | |a PATIENTS/PARTICIPANTS: 106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively | ||
| 520 | |a INTERVENTION: Functional bracing | ||
| 520 | |a MAIN OUTCOME MEASUREMENTS: Failure of nonoperative management, defined as conversion to surgery, malunion, and delayed union/nonunion | ||
| 520 | |a RESULTS: Nonoperative management failed in 33 (31%) of 106 included patients with 27 patients (25%) requiring surgery. On multivariate analysis, female sex [odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21], American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior-posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11 degrees (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, 1, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively | ||
| 520 | |a CONCLUSIONS: Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cut-off values were established that may be used by surgeons to counsel patients with these injuries | ||
| 520 | |a LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence | ||
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| 700 | 1 | |a Bowers, Mathew R |e verfasserin |4 aut | |
| 700 | 1 | |a Lauder, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Parry, Joshua A |e verfasserin |4 aut | |
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