Humeral Shaft Fractures: Surgical versus Nonsurgical Management in Workers’ Compensation

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

2 Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA

Abstract

Background: The optimal surgical indications for humeral shaft fractures in the working population remain uncertain.
This study investigates the impact of surgical fixation on return to duty, union, and complications in workers’ compensation
patients with humeral shaft fractures.
Methods: All workers’ compensation patients with humeral shaft fractures managed at a single institution between
2007 and 2017 were identified. Manual chart and radiographic review was performed to identify etiology of injury, type
of work, time until return to duty, length of physical therapy, complications, and time to fracture union.
Results: There were 39 humeral shaft fractures in workers’ compensation patients managed at our institution (25
surgical; 64.1%). There was no difference in the return to light (106.1 versus 60.4 days; P=0.20) or full (140.1 vs.
139.9 days; P=0.99) duty for surgical versus nonsurgical treatment, respectively. There was no difference in the
length of physical therapy (132.6 versus 106.3 days; P=0.15) or time to maximum medical improvement (174.3 vs.
198.8 days; P=0.25) for surgical versus nonsurgical treatment, respectively. Three patients returned to the operating
room in the surgical group. Nonunion was observed in two surgical cases (8.0%) and one case (7.1%) of nonsurgical
management.
Conclusion: This study did not identify an advantage for faster return to work after surgical management of humeral
shaft fractures in workers’ compensation patients. Though one of the perceived advantages of surgical fixation is a
quicker return to physical activity, there may be other variables in this patient population that influence the timing of
return to work.
Level of evidence: III

Keywords

References

1. Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist
H, Ponzer S. Fractures of the shaft of the humerus: an
epidemiological study of 401 fractures. The Journal
of Bone and Joint Surgery. British volume. 2006;
88(11):1469-73.
2. Rose SH, Melton LJ, Morrey BF, Ilstrup DM, Riggs
BL. Epidemiologic features of humeral fractures.
Clinical Orthopaedics and Related Research®. 1982;
(168)24–30.
3. Tytherleigh-Strong G, Walls N, McQueen MM. The
epidemiology of humeral shaft fractures. The Journal
of bone and joint surgery. British volume. 1998;
80(2):249-53.
4. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA.
Functional bracing for the treatment of fractures of
the humeral diaphysis. JBJS. 2000; 82(4):478.
5. Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van
Rensburg L. Nonoperative treatment of humeral shaft
fractures revisited. Journal of shoulder and elbow
surgery. 2015; 24(2):210-4.
6. Denard A, Richards JE, Obremskey WT, Tucker MC,
Floyd M, Herzog GA. Outcome of nonoperative vs
operative treatment of humeral shaft fractures: a
retrospective study of 213 patients. Orthopedics.
2010; 33(8).
7. Ekholm R, Tidermark J, Törnkvist H, Adami J, Ponzer S.
Outcome after closed functional treatment of humeral
shaft fractures. Journal of orthopaedic trauma. 2006;
20(9):591-6.
8. Rutgers M, Ring D. Treatment of diaphyseal fractures
of the humerus using a functional brace. Journal of
orthopaedic trauma. 2006; 20(9):597-601.
9. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE,
Järvinen MJ. Functional treatment of closed humeral
shaft fractures. International orthopaedics. 2005;
29(1):10-3.
10. Huttunen TT, Kannus P, Lepola V, Pihlajamäki H,
Mattila VM. Surgical treatment of humeral-shaft
fractures: a register-based study in Finland between
1987 and 2009. Injury. 2012; 43(10):1704-8.
11. Schoch BS, Padegimas EM, Maltenfort M, Krieg
J, Namdari S. Humeral shaft fractures: national
trends in management. Journal of Orthopaedics and
Traumatology. 2017; 18(3):259.
12. Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark
J. Primary radial nerve palsy in patients with acute
humeral shaft fractures. Journal of orthopaedic
trauma. 2008; 22(6):408-14.
13. Klestil T, Rangger CH, Kathrein A, Brenner E, Beck E.
Konservative und operative Therapie traumatischer
Oberarmschaftbrüche. Der Chirurg. 1997; 68(11):
1132-6.
14. Mahabier KC, Vogels LM, Punt BJ, Roukema GR,
Patka P, Van Lieshout EM. Humeral shaft fractures:
retrospective results of non-operative and operative
treatment of 186 patients. Injury. 2013; 44(4):427-30.
15. Van Middendorp JJ, Kazacsay F, Lichtenhahn P, Renner
N, Babst R, Melcher G. Outcomes following operative
and non-operative management of humeral midshaft
fractures: a prospective, observational cohort study
of 47 patients. European Journal of Trauma and
Emergency Surgery. 2011; 37(3):287.
16. Wallny T, Sagebiel C, Westerman K, Wagner UA, Reimer
M. Comparative results of bracing and interlocking
nailing in the treatment of humeral shaft fractures.
International orthopaedics. 1998; 21(6):374-9.
17. Banerjee M, Balke M, Bouillon B, Titze F, Shafizadeh
S. Soft tissue injury of the shoulder after single nondislocating
trauma: prevalence and spectrum of
intraoperative findings during shoulder arthroscopy
and treatment results. Archives of orthopaedic and
trauma surgery. 2015; 135(1):103-9.
18. Bouchard A, Garret J, Favard L, Charles H, Ollat D.
Failed subacromial decompression. Risk factors.
Orthopaedics & Traumatology: Surgery & Research.
2014; 100(8):S365-9.
19. Chen AL, Bain EB, Horan MP, Hawkins RJ. Determinants
of patient satisfaction with outcome after shoulder
arthroplasty. Journal of shoulder and elbow surgery.
2007; 16(1):25-30.
20. Gruson KI, Huang K, Wanich T, DePalma AA. Workers’
compensation and outcomes of upper extremity
surgery. JAAOS-Journal of the American Academy of
Orthopaedic Surgeons. 2013; 21(2):67-77.
21. Holtby R, Razmjou H. Impact of work-related
compensation claims on surgical outcome of patients
with rotator cuff related pathologies: a matched casecontrol
study. Journal of shoulder and elbow surgery.
2010; 19(3):452-60.
22. Jawa A, Dasti UR, Fasulo SM, Vaickus MH, Curtis AS,
Miller SL. Anatomic total shoulder arthroplasty for
patients receiving workers’ compensation. Journal of
Shoulder and Elbow Surgery. 2015; 24(11):1694-7.
23. Morris BJ, Haigler RE, Laughlin MS, Elkousy HA,
Gartsman GM, Edwards TB. Workers’ compensation
claims and outcomes after reverse shoulder
arthroplasty. Journal of shoulder and elbow surgery.
2015; 24(3):453-9.
24. Pensak M, Grumet RC, Slabaugh MA, Bach Jr BR.
Open versus arthroscopic distal clavicle resection.
Arthroscopy: The Journal of Arthroscopic & Related
Surgery. 2010; 26(5):697-704.
25. Koch PP, Gross DF, Gerber C. The results of functional
(Sarmiento) bracing of humeral shaft fractures.
Journal of shoulder and elbow surgery. 2002;
11(2):143-50.
26. Shields E, Thirukumaran C, Thorsness R, Noyes K,
Voloshin I. Patient factors influencing return to work
and cumulative financial claims after clavicle fractures
in workers’ compensation cases. Journal of Shoulder
and Elbow Surgery. 2016; 25(7):1115-21.
27. Fan Y, Li YW, Zhang HB, Liu JF, Han XM, Chang X, et 
al. Management of humeral shaft fractures with
intramedullary interlocking nail versus locking
compression plate. Orthopedics. 2015; 38(9):e825-9.
28. Wali MG, Baba AN, Latoo IA, Bhat NA, Baba OK,
Sharma S. Internal fixation of shaft humerus fractures
by dynamic compression plate or interlocking
intramedullary nail: a prospective, randomised study.
Strategies in Trauma and Limb Reconstruction. 2014;
9(3):133-40.
29. Changulani M, Jain UK, Keswani T. Comparison of the
use of the humerus intramedullary nail and dynamic
compression plate for the management of diaphyseal
fractures of the humerus. A randomised controlled
study. International orthopaedics. 2007; 31(3):391-5.
30. Bhandari M, Devereaux PJ, D Mckee M, H Schemitsch
E. Compression plating versus intramedullary nailing
of humeral shaft fractures—a meta-analysis. Acta
orthopaedica. 2006; 77(2):279-84.
31. Hohmann E, Glatt V, Tetsworth K. Minimally invasive
plating versus either open reduction and plate
fixation or intramedullary nailing of humeral shaft
fractures: a systematic review and meta-analysis of
randomized controlled trials. Journal of shoulder and
elbow surgery. 2016; 25(10):1634-42.
32. Ma J, Xing D, Ma X, Gao F, Wei Q, Jia H, et al.
Intramedullary nail versus dynamic compression
plate fixation in treating humeral shaft fractures:
grading the evidence through a meta-analysis. PLoS
One. 2013; 8(12):e82075.
The Archives of Bone and Joint Surgery
Volume 8, Issue 6
November and December 2020
Pages 668-674

Files

History

  • Receive Date: 20 February 2020
  • Revise Date: 21 April 2020
  • Accept Date: 05 May 2020

Share

How to cite

Statistics