OBJECTIVES: The primary aim was to assess patient-reported outcomes ≥1yr following a humeral diaphyseal fracture. The secondary aim was to compare outcomes of patients who united after initial management (operative/non-operative) with those who united after nonunion fixation (NU-ORIF).
SETTING: University teaching hospital.
PATIENTS AND INTERVENTION: From 2008-2017, 291 patients (mean age 55yrs [17-86], 58% [n=168/291] female) were available to complete an outcomes survey. Sixty-four (22%) were initially managed operatively and 227 (78%) non-operatively. After initial management, 227 (78%) united (n=62 operative, n=165 non-operative), two had a delayed union (both non-operative) and 62 (21%) a nonunion (n=2 operative, n=60 non-operative). Fifty-two patients (93%, n=52/56) united after NU-ORIF.
MAIN OUTCOME MEASUREMENTS: QuickDASH, EuroQol-5 Dimension (EQ-5D)/Visual Analogue Scale (EQ-VAS), 12-item Short Form Physical (PCS) and Mental Component Summary (MCS).
RESULTS: At a mean of 5.5yrs (1.2-11.0) post-injury, the mean QuickDASH was 20.8, EQ-5D 0.730, EQ-VAS 74, PCS 44.8 and MCS 50.2. Patients who united after NU-ORIF reported worse function (QuickDASH 27.9 vs. 17.6, p=0.003) and health-related quality of life (HRQoL; EQ-5D 0.639 vs. 0.766, p=0.008; EQ-VAS 66 vs. 76, p=0.036; PCS 41.8 vs. 46.1, p=0.036) than those who united primarily. Adjusting for confounders, union after NU-ORIF was independently associated with a poorer QuickDASH (difference 8.1, p=0.019) and EQ-5D (difference -0.102, p=0.028).
CONCLUSIONS: Humeral diaphyseal union after NU-ORIF resulted in poorer patient-reported outcomes compared to union after initial management. Targeting early operative intervention to at-risk patients may mitigate the potential impact of nonunion on longer-term outcome.
LEVEL OF EVIDENCE: Prognostic Level III.. See Instructions for Authors for a complete description of levels of evidence.