Intramedullary Nail Versus Plate Fixation for Diaphyseal Humerus Fractures: A Retrospective Comparative Analysis.
Urvi Patel, M.D.1, Melissa R Holloway, B.S.1, Thomas Carroll, M.D.1, Sandeep Soin, MD2 and John Ketz, M.D.1, (1)University of Rochester Medical Center, Rochester, NY, (2)URMC, Rochester, NY
Introduction: The purpose of this study is to analyze the outcomes following intramedullary nail (IMN) fixation versus open reduction and internal fixation (ORIF) in patients with diaphyseal humeral shaft fractures. We specifically seek to compare time to radiographic union, complication rates, operative times, operative blood loss, and functional outcomes. We hypothesize comparable outcomes between the two groups.
Methods: We retrospectively reviewed patients undergoing surgical intervention for diaphyseal humeral shaft fractures at our institution. 193 patients met our inclusion criteria. Patients under the age of 18, those with impending pathologic fracture, and those with intra-articular fracture extension were excluded. Demographic characteristics, OTA fracture classification, time to union, complications, operative details, and PROMIS outcomes were reviewed and analyzed. Statistical significance was set at p<0.05.
Results: In our cohort, 152 patients underwent ORIF and 41 patients underwent IMN fixation for their humeral shaft fracture. Mean age at time of fixation was 50±20 for ORIF and 66±15 for IMN (p<0.01). Time to surgery averaged 5.42±10.7 days and 7.52±7.16 days for the ORIF and IMN groups, respectively (p=0.24). Mean intraoperative blood loss was 333±315 cc for the ORIF cohort and 155±126 cc for the IMN cohort (p=0.008). Total operative time was 214±86 mins and 191±58 mins for the ORIF and IMN groups, respectively (p=0.21). Time to union was 17.8±9.3 weeks in the ORIF group and 19.1±10.6 weeks in the IMN group (p=0.23). Six patients in the ORIF group and 4 patients in the IMN group went on to non-union (p=0.15). 29 patients in the ORIF group and 2 patients in the IMN group had new-onset radial nerve palsy post-operatively (p=0.04), which were significantly predicted by increased time to surgery (p=0.02) and OTA fracture classification type A (p=0.01). There was no significant difference in PROMIS scores across the two groups.
Conclusion: Ultimately, our study shows that IMN fixation for diaphyseal humerus fractures presents with lower rates of intraoperative blood loss and iatrogenic radial nerve injury. Factors which predicted radial nerve injuries were longer times to surgery and OTA classified type A fractures. Total operative time, time to union, PROMIS scores, and the incidence of nonunion and postoperative infections were equivocal between the two cohorts.
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