A radiographic analysis of humerus shaft fractures to predict non-union

TL;DR

This study shows that initial radiographic displacement in humerus shaft fractures can predict whether non-surgical treatment will fail.

Contribution

The study identifies specific radiographic parameters that predict non-union in non-operatively treated humeral shaft fractures.

Findings

Non-operative treatment failure was associated with increased AP translation on lateral radiographs.

Failed conservative treatment was more common in older patients and females.

Significant AP displacement may help guide surgical intervention decisions.

Abstract

Humeral shaft fracture non-union rates of up to 33% have been reported when managed non-operatively. When managed surgically, non-union rates of 10% have been seen. The initial radiographic displacement parameters may be of significance in determining whether non-operative treatment might fail.

To determine whether the initial radiographic displacement of humeral shaft fractures can predict non-union rates and assist in decision-making for surgical intervention.

A retrospective cohort study was performed to identify all patients with humeral shaft fractures presenting to a regional trauma centre over a three-year period. Three-observer measurements were taken on defined radiographic parameters. These were compared between groups treated successfully with surgery and with non-operative intervention. A subset group was identified who failed non-operative treatment and required delayed surgery. Statistical analysis was performed to determine whether the group that failed non-operative treatment met the proposed radiographic parameters predicting treatment failure.

Eighty patients were identified over the defined three-year period. Failure of non-operative management occurred in 6/43 (13.95%) patients. Failed conservative treatment was associated with increased age, female gender, and increased AP translation of lateral radiographs. Fractures successfully treated non-operatively showed a significantly lower AP translation on the lateral radiographs compared to patients who failed non-operative treatment 9.69 mm (IQR 4.90–14.05 mm) versus 22.61 mm (IQR 15.73–23.83 mm), p-value = 0.042.

Significant initial AP displacement may be associated with failure of non-operative management. This study highlights the importance of initial radiographic parameters of displacement in predicting possible failure of non-operative management for midshaft humerus fractures.

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