Abstract
Background: Fractures of shaft of humerus are common, they account for 3% of all the orthopedic injuries, and it resulted in a significant load to society because of loss productivity and wages. Operative treatment is done with the help of external fixation, intramedullary nailing, or plate-and-screw fixation, with each method showing a high rate of union. The present study was conducted with the aim to compare the outcome of operative and non-operative management of humeral shaft fractures.
Materials and Methods: The present retrospective study was conducted in the department of orthopedics for a period of 2 years, Subjects more than 18 years were included in the study. The mechanism of trauma, treatment received and signs of radial palsy were noted in all the cases. All the data was arranged in a tabulated form and analyzed using SPSS software. Chi square test was used to determine the level significance. Probability value of less than 0.05 was considered as significant.
Results: The study enrolled 60 subjects, out of which 30 were managed operatively and 30 were managed non-operatively. The mean age of the subjects was 42.45+/- 6.37 years. There were 35 males and 25 females. The mean total time for type A fractures was 15 weeks with the range of 12-18 weeks. The mean total time for type B fractures was 16 weeks with the range of 13-23 weeks. Delayed union was seen in a total of 20% (n=12) cases, out of which 23.3% (n=7) were that of non-operative group and 16.7% (n=5) were that of operative group.
Conclusion: According to the present study, there was no significant difference in the operative and non-operative surgical treatment modality. The study observed similar rates of delayed union and radial nerve palsy in both operative and non-operative treatment modality.
Keywords: humerus, intramedullary, orthopedics.
References
- Epps CH Jr, Grant RE. Fractures of the shaft of the humerus. In: Rockwood CA Jr, Green DP, Bucholz RW, editors. Rockwood and Green’s fractures in adults. 3rd ed. Philadelphia: Lippincott Williams & Williams; 1991.
- Praemer MA, Furner S, Price DP. Musculoskeletal conditions in theUnited States. Park Ridge (IL): American Academy of Orthopaedic Surgeons 1992.
- Tsai CH, Fong YC, Chen YH, Hsu CJ, Chang CH, Hsu HC. The epidemiology of traumatic humeral shaft fractures in Taiwan. IntOrthop 2009;33:463-7. doi:10.1007/s00264-008-0537-8
- Brorson S. Management of fractures of the humerus in Ancient Egypt, Greece, and Rome: an historical review. Clin Orthop Relat Res 2009; 467:1907-14. doi:10.1007/s11999-008-0612-x
- Browner BD, Levine AM, Jupiter JB, Trafton PG. Skeletal trauma. Philadelphia: Saunders; 1998
- Sarmiento A, Waddell JP, Latta LL. Diaphyseal humeral fractures: treatment options. Instr Course Lect 2002;51:257-69.
- Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of humeral shaft fracturesda meta-analysis. Acta Orthop 2006;77:279-84.
- Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 2000;14:162-6.
- Martinez AA, Cuenca J, Herrera A. Treatment of humeral shaft nonunions: nailing versus plating. Arch Orthop Trauma Surg 2004; 124:92-5. doi:10.1007/s00402-003-0608-7
- Foster RJ, Dixon GL Jr, Bach AW, Appleyard RW, Green TM. Internal fixation of fractures and non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg Am 1985;67:857- 64.
- Denard AJ, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA. Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. 2010;33(8).
- Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg. 2015;24(2):210–4.
- Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. 2006;37(8):691–7.
- Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br. 1998;80(2):249–53.
- Kim SH, Szabo RM, Marder RA. Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res (Hoboken). 2012;64(3):407–14.
- DeFranco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. J Hand Surg Am 2006;31(4): 655-63. 247
- Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 249 2005;87(12): 1647-52.
- Schittko A. [Humeral shaft fractures] Humerusschaftfrakturen. Chirurg 2004; 75(8): 833-222 46; quiz 847.
- Mahabier KC, Vogels LM, Punt BJ, Roukema GR, Patka P, Van Lieshout EM. Humeral shaft fractures: retrospective results of non-operative and operative treatment of 186 patients. 2013;44(4):427–30.
Corresponding Author
Dr Vikas Verma
Senior Resident, Department of Orthopedics
SMS Medical College, Jaipur, Rajasthan, India