Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures |
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| Affiliation: | 1. Universidade Federal Fluminense. Marquês de Paraná St, 303 - Centro, Niterói, RJ;2. Hospital Universitário da Universidade Federal Juiz de Fora. Eugênio do Nascimento Av, S/N. Juiz de Fora-MG, Brasil;3. Hospital Santa Teresa. Paulino Afonso St, 477 - Centro. Petrópolis-RJ, Brasil;4. Hospital HTO-Dona Lindu. Nações Av - Limoeiro. Paraíba do Sul-RJ, Brasil;5. Universidade Federal de Minas Gerais. Prof. Alfredo Balena Av, 190 - Santa Efigênia. Belo Horizonte-MG, Brasil;1. Clinical Medical School, University of Queensland, Brisbane, QLD, Australia;2. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia;3. Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, QLD, Australia;4. Department of Surgery, School of Medicine, University of Queensland, Brisbane, QLD, Australia;5. Queensland University of Technology, Brisbane, QLD, Australia;6. Orthopaedic Research Institute of Australia, Brisbane, QLD, Australia |
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| Abstract: | IntroductionThis study was designed to measure early postoperative outcomes of plate vs. nail fixation for humeral shaft fractures.Patients and methodsPatients ≥18 years who underwent plate or nail fixation for low-energy humeral shaft fractures between 2005–2016 were identified from the National Surgical Quality Improvement Program (NSQIP). Multivariable regression was used to compare postoperative outcomes using propensity score adjustment to account for differences between fixation groups. Variables included in the propensity score were age, American Society of Anesthesiologists (ASA) class, hypertension, steroid use, cancer, functional status, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and sex.ResultsPlate fixation was used in 1418 patients (70.6%), while nail fixation was used in 591 (29.4%). Patients undergoing nail fixation were more likely to be older, have a higher American Society of Anesthesiologists (ASA) class, and have comorbidities. Mean operative time was statistically longer in the plate fixation group (130 +/−62 min vs. 102 +/−54 min). After propensity score adjustment, type of fixation was not a significant predictor of major or minor complications, length of stay, or readmission. However, nail fixation was a significant predictor of mortality following propensity score adjustment (OR 3.15, 95% Confidence interval 1.26–7.85).ConclusionPatients undergoing intramedullary nail fixation tended to be older patients with more comorbidities, suggesting that surgeons are selecting nail fixation in patients who may not be ideal surgical candidates. Although LOS, complications, and readmission rates were higher in the nail group, this difference was not statistically significant following propensity score adjustment. However, nail fixation remained an independent predictor of 30-day mortality following adjustment. This suggests that nail fixation may not be a safer surgical option in patients with multiple medical co-morbidities and low-energy humeral shaft fractures. |
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| Keywords: | Humerus Shaft Fracture Nail Plate Outcomes Morbidity Mortality Complication |
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