Paul Tornetta III
VANCOUVER, British Columbia — Lack of motion after 8 weeks predicted union in patients treated nonoperatively for humeral shaft fractures, and surgical intervention may be beneficial for patients with gross motion but who lack of callus formation at this time, according to a presenter at the Orthopaedic Trauma Association Annual Meeting.
“VAS pain was not helpful in determining who would go on to surgery,” Paul Tornetta III, MD, said during his presentation. “So, the patient who has gross motion, does not have a lot of callus formation at 8 weeks — based on this, we would consider the discussion of earlier intervention and avoid that in patients who have no motion.”
Tornetta and colleagues screened all patients with acute humeral shaft fractures at 13 centers as part of a comparative study and identified 80 patients who were treated nonoperatively with a functional brace. At 4 weeks, 8 weeks, 12 weeks, 26 weeks and 52 weeks of follow-up, patients were examined for gross motion at the fracture site, VAS pain and the presence of callus on all four cortices. At 8 weeks, investigators compared patients with gross motion vs. those without it.
Results showed BMI and injury severity score were not significantly different between patients with motion and those without it. Investigators noted at 8 weeks, there were 62 patients who did not have motion at the fracture site, while 18 patients had gross motion. There were 58 patients without motion who went on to union.
Of the 18 patients who had gross motion at 8 weeks, two were lost to follow-up; seven healed and the remaining nine went on to surgery. After 8 weeks, there was no significant difference in VAS scores between patients who had gross motion and fractures that united and patients who did not. In six of the seven patients who went on to union, callus formation was present in three of the four cortices. Callus formation was present in three of the nine patients who went on to surgery.
According to researchers, apart from patients who were lost to follow-up after 8 weeks, the positive predictive value and negative predictive value for lack of motion that resulted in union without the need for surgery was 100% and 56%, respectively. – by Monica Jaramillo
Tornetta P III, et al. Paper #67. Presented at: Orthopaedic Trauma Association Annual Meeting. Oct. 11-14, 2017; Vancouver, British Columbia.
Disclosure: Tornetta reports he receives royalties from Smith & Nephew; receives royalties and financial or material support from Wolters Kluwer Health – Lippincott Williams & Wilkins and is on the editorial/ governing board for the Journal of Orthopaedic Trauma.