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Background <p>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.</p> Aims <p>To determine whether the initial radiographic displacement of humeral shaft fractures can predict non-union rates and assist in decision-making for surgical intervention.</p> Methods <p>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.</p> Results <p>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&#xa0;mm (IQR 4.90–14.05&#xa0;mm) versus 22.61&#xa0;mm (IQR 15.73–23.83&#xa0;mm), <i>p</i>-value = 0.042.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月15日

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  • Alexander Price,
  • Conor O’Driscoll,
  • Nicolaas Kotze,
  • Danilo Vukanic,
  • Petr Jemelik,
  • May Cleary,
  • David O’Briain

摘要

Background

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.

Aims

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

Methods

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.

Results

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.

Conclusion

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.