Factors associated with patient-reported outcomes following a humeral shaft fracture: Nonunion results in a poorer outcome despite union after surgical fixation

William M Oliver; Henry K C Searle; Samuel G Molyneux; Timothy O White; Nicholas D Clement; Andrew D Duckworth

doi:10.1097/BOT.0000000000002315

Factors associated with patient-reported outcomes following a humeral shaft fracture: Nonunion results in a poorer outcome despite union after surgical fixation

William M Oliver, Henry K C Searle, Samuel G Molyneux, Timothy O White, Nicholas D Clement, Andrew D Duckworth

Research output: Contribution to journal › Article › peer-review

Abstract

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).

DESIGN: Retrospective.

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.

Original language	English
Pages (from-to)	e227-e235
Journal	Journal of Orthopaedic Trauma
Volume	36
Issue number	6
Early online date	5 Jan 2022
DOIs	https://doi.org/10.1097/BOT.0000000000002315
Publication status	Published - 1 Jun 2022

Keywords / Materials (for Non-textual outputs)

Female
Fracture Fixation, Internal/methods
Fracture Healing
Humans
Humeral Fractures/complications
Humerus
Middle Aged
Patient Reported Outcome Measures
Quality of Life
Retrospective Studies
Treatment Outcome

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10.1097/BOT.0000000000002315

Factors associated with patient-reported outcomes following a humeral shaft fractureAccepted author manuscript, 493 KBLicence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

Cite this

@article{efd873a9fdfd48f5b05c7f27f664b26a,

title = "Factors associated with patient-reported outcomes following a humeral shaft fracture: Nonunion results in a poorer outcome despite union after surgical fixation",

abstract = "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).DESIGN: Retrospective.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.",

keywords = "Female, Fracture Fixation, Internal/methods, Fracture Healing, Humans, Humeral Fractures/complications, Humerus, Middle Aged, Patient Reported Outcome Measures, Quality of Life, Retrospective Studies, Treatment Outcome",

author = "Oliver, \{William M\} and Searle, \{Henry K C\} and Molyneux, \{Samuel G\} and White, \{Timothy O\} and Clement, \{Nicholas D\} and Duckworth, \{Andrew D\}",

note = "Funding Information: The study was carried out with the support of the Scottish Orthopaedic Research Trust into Trauma (SORT-iT). Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = jun,

day = "1",

doi = "10.1097/BOT.0000000000002315",

language = "English",

volume = "36",

pages = "e227--e235",

journal = "Journal of Orthopaedic Trauma",

issn = "0890-5339",

publisher = "Wolters Kluwer Health",

number = "6",

}

Factors associated with patient-reported outcomes following a humeral shaft fracture: Nonunion results in a poorer outcome despite union after surgical fixation. / Oliver, William M; Searle, Henry K C; Molyneux, Samuel G et al.
In: Journal of Orthopaedic Trauma, Vol. 36, No. 6, 01.06.2022, p. e227-e235.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Factors associated with patient-reported outcomes following a humeral shaft fracture

T2 - Nonunion results in a poorer outcome despite union after surgical fixation

AU - Oliver, William M

AU - Searle, Henry K C

AU - Molyneux, Samuel G

AU - White, Timothy O

AU - Clement, Nicholas D

AU - Duckworth, Andrew D

N1 - Funding Information: The study was carried out with the support of the Scottish Orthopaedic Research Trust into Trauma (SORT-iT). Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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).DESIGN: Retrospective.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.

AB - 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).DESIGN: Retrospective.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.

KW - Female

KW - Fracture Fixation, Internal/methods

KW - Fracture Healing

KW - Humans

KW - Humeral Fractures/complications

KW - Humerus

KW - Middle Aged

KW - Patient Reported Outcome Measures

KW - Quality of Life

KW - Retrospective Studies

KW - Treatment Outcome

U2 - 10.1097/BOT.0000000000002315

DO - 10.1097/BOT.0000000000002315

M3 - Article

C2 - 34999623

SN - 0890-5339

VL - 36

SP - e227-e235

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

IS - 6

ER -

Factors associated with patient-reported outcomes following a humeral shaft fracture: Nonunion results in a poorer outcome despite union after surgical fixation

Abstract

Keywords / Materials (for Non-textual outputs)

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