Humeral shaft fracture: a randomized controlled trial of nonoperative versus operative management (plate fixation)
Received 21 April 2019
Accepted for publication 4 September 2019
Published 23 September 2019 Volume 2019:11 Pages 141—147
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Nicola Ludin
Peer reviewer comments 2
Editor who approved publication: Professor Clark Hung
Seyed Mahdi Hosseini Khameneh,1 Mohammadreza Abbasian,1 Hashem Abrishamkarzadeh,1,2 Shahab Bagheri,3 Fahimeh Abdollahimajd,4 Farshad Safdari,5 Shahram Rahimi-Dehgolan6
1Orthopedic Surgery Department, Bone, Joint, and Related Tissues Research Center, Akhtar Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Orthopedic Surgery Department, AJA University of Medical Sciences, Tehran, Iran; 3Physical Medicine and Rehabilitation Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5Orthotics and Prosthetics Department, Bone, Joint, and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 6Physical Medicine and Rehabilitation Department, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Correspondence: Hashem Abrishamkarzadeh
Orthopedic Surgery Department, Bone, Joint, and Related Tissues Research Center, Akhtar Educational Hospital, Shahid Beheshti University of Medical Sciences, Sharifi Manesh Street, Poule Roomi Avenue, Shariati Street, Tehran 1964714953, Iran
Tel/fax +98 212 207 4090
Physical Medicine and Rehabilitation Department, IKHC Center, Keshavarz Boulevard, Tehran 1419733141, Iran
Tel/fax +98 216 1190
Purpose: This randomized controlled trial was conducted to investigate the outcomes of humeral shaft–fracture management with the functional Sarmiento brace (nonoperative) versus open reduction internal fixation (ORIF).
Methods: Sixty humeral shaft–fracture patients with a minimum age of 18 years were randomly assigned into two groups: operative treatment with open reduction–internal fixation (ORIF) or functional brace (Sarmiento). A similar postoperative rehabilitation program was applied for all subjects for the next 12 months. The outcomes of each method were measured in terms of nonunion rate, union time, “quick” Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire scores, and rate of complications, such as malunion, infection, and radial nerve injury.
Results: The two groups had similar baseline characteristics, including age, sex, smoking status, and type and mechanism of fracture. The mean union time was about 4.8 weeks shorter in the ORIF group (13.9 weeks in operative group versus 18.7 weeks in nonoperative group), indicating a definite significant superiority (p=0.001) of ORIF management to functional Sarmiento bracing. However, a comparison of quick DASH scores revealed a borderline-significant difference between the groups (p=0.065). Additionally, we found that treatment of humeral shaft fractures using functional bracing was associated with slightly higher risk of nonunion; however this was not significant (p=0.492).
Conclusion: According to the present findings, there is remarkable superiority of ORIF over functional Sarmiento bracing in the management of patients with humeral shaft fracture.
Keywords: diaphyseal fracture, functional brace, open reduction internal fixation, malunion, nonunion
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