Abstract
Aim: To evaluate outcomes in humeral shaft fractures treated non-operatively and to identify possible causes for non-union.
Methods: Patients were identified through a manual search of the operating theatre register and all plaster room forms for the period 1/1/02 – 31/12/05. Patient files and radiographs were then examined for factors that might influence rate of non-union.
Results: 45 fractures were identified in 44 patients. 28 of these were treated conservatively with a hanging cast and functional brace. Of these, 11(39.6%) went onto non-union requiring ORIF + bone grafting.
There was a strong correlation between the length of time spent in the hanging cast and a high rate of non-union. The average length of time spent in cast for the non-union group was 48 days as opposed to 30.9days in the group that went onto unite (p=0.0601)
There was a statistically significant correlation between non-union and the radiographic degree of distraction at the time of first application of hanging cast (p=0.016) and also at the six week check (p=0.001).
Other factors associated with a poor outcome were the degree of varus angulation at presentation (p=0.0078), male sex, right humerus, dominant side, older age group, high energy injury, NSAID use, significant co-morbidities and associated injuries.
Conclusions: Our results compares unfavorably with Sarmiento who quotes a non-union rate of 2.5% in patients who are treated on average only 9 days in hanging cast. Our high rate of non-union is associated with a high degree of distraction at time of first application of hanging cast and an extended period of time spent in cast.
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