Orthopaedic Trauma Association Annual Meeting

Orthopaedic Trauma Association Annual Meeting

Perspective from Toni M. McLaurin, MD, FAAOS
Source: Schneider P, et al. Paper 60. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20 - 23, 2021; Fort Worth, Texas.
Disclosures: Schneider reports being a paid presenter or speaker for Amgen Co. and Synthes; receiving research support from Johnson & Johnson; being on the editorial or governing board for the Canadian Journal of Surgery; and being a board or committee member for the Canadian Orthopaedic Association.
November 09, 2021
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ORIF yielded better outcomes than nonoperative treatment for humeral diaphyseal fractures

Perspective from Toni M. McLaurin, MD, FAAOS
Source: Schneider P, et al. Paper 60. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20 - 23, 2021; Fort Worth, Texas.
Disclosures: Schneider reports being a paid presenter or speaker for Amgen Co. and Synthes; receiving research support from Johnson & Johnson; being on the editorial or governing board for the Canadian Journal of Surgery; and being a board or committee member for the Canadian Orthopaedic Association.
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Compared with nonoperative treatment, open reduction and internal fixation with a plate and screw construct yielded improved function at 6 weeks and 4 months in patients with humeral diaphyseal fractures, presented results showed.

“Humeral shaft fractures are fairly common and, unfortunately, our standard treatment with nonoperative care involving casts and slings still carries a symptomatic nonunion rate as high as 33% in the literature,” Prism Schneider, MD, PhD, FRCSC, said in her presentation at the Orthopaedic Trauma Association Annual Meeting.

OT1121Schneider_OTA_Graphic_01
After 4 months, researchers found no significant differences in mean DASH scores between the ORIF group and the nonoperative group. Data were derived from Schneider P. Paper 60. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 20 - Oct. 23, 2021; Fort Worth, Texas (hybrid meeting).

From Nov. 13, 2009 to Feb. 4, 2020, Schneider and colleagues randomized 84 patients with isolated, closed humeral diaphyseal fractures to open reduction and internal fixation (ORIF) with a plate and screw construct and a matched cohort of 84 patients – also with isolated, closed humeral diaphyseal fractures – to nonoperative treatment, which included splinting followed by bracing.

According to the abstract, outcome measures included DASH score, short musculoskeletal functional assessment, Constant shoulder score, range of motion (ROM), time to union and radiographic factors.

At 6-week and 4-month follow-ups, the ORIF group had mean DASH scores of 33.8 and 21.6, respectively, while the nonoperative group had mean DASH scores of 56.5 and 31.6, respectively. However, at 12-month follow-up, researchers found no significant differences in mean DASH scores between the ORIF group (8.8) and the nonoperative group (11). ROM, time to union and complication rate were also better in the ORIF group up to 4 months, Schneider noted.

“For isolated, closed diaphyseal fractures of the humerus, regardless of age, BMI, type of fracture or smoking status, if you’re counseling your patient, this is still shared decision-making,” Schneider said. “If you go with nonoperative treatment, we now have fairly robust data support that the union make take 4 to 6 months. There is a 15.5% risk of nonunion requiring surgery, and shoulder strength and ROM may be limited up to 4 months,” she added.