No Differences in Clinical, Functional, or Patient-Reported Outcomes Following Trial of Non-operative Management Prior to Open Reduction and Internal Fixation of Humeral Shaft Fractures.

Abstract

Objectives: To test the hypothesis that primary osteosynthesis of humeral shaft fractures may lead to more favorable clinical, functional, and patient-reported outcomes than fixation following a trial of nonoperative management. Methods: Design: Retrospective Cohort Review. Setting: Academic Level I Trauma Center. Patient Selection Criteria: Adult patients who presented with humeral shaft fractures, and ultimately underwent open reduction and internal fixation (ORIF) from 05/2011 to 05/2021. Patients who underwent ORIF within 2 weeks of injury were grouped into the primary osteosynthesis cohort, and patients who underwent ORIF >4 weeks from date of injury were grouped into the trial of nonoperative cohort. Outcome Measures and Comparisons: Post-operative complications, elbow arc of motion, time to radiographic union, and patient-reported outcomes were investigated and compared between the primary osteosynthesis and trial of nonoperative management cohorts. Results: 127 patients fit the study criteria, 84 underwent primary osteosynthesis and 43 trialed initial non-operative treatment. No differences were found in patient demographics between the primary osteosynthesis and trial of non-operative management cohorts, including age (53±19 vs. 57±18; p=0.25), sex (39% vs. 44% male, 61% vs. 56% female; p=0.70), and BMI (30±6 vs. 32±9; p=0.38) . The average time to operative intervention in the primary osteosynthesis group was 4 days (0-14 days), and 105 days (28-332 days) in the trial of non-operative treatment group (p<0.01). No differences were found with regards to intra-operative blood loss, total operative time, time to radiographic union (determined using the RUSHu scoring system), or overall complication rates, including primary and secondary radial nerve injuries (P=0.23 and 0.86, respectively). Patients reported similar PROMIS Pain Interference (PI) (P=0.73), Depression (D) (P=0.99), and Physical Function (PF) (P=0.66) scores at their 6-month post-surgical follow up visits. Conclusion: Patients who attempted a trial of non-operative management for humeral shaft fractures prior to open reduction and internal fixation had similar clinical, functional, and patient reported outcomes as those who underwent primary osteosynthesis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.