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Iatrogenic open humeral shaft fractures following functional bracing

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The treatment of closed humeral shaft fractures tends to be successful with functional bracing. Treatment failure due to iatrogenic conversion to an open fracture has not been described in the literature. We present a case series of patients that experienced open humeral shaft fractures after initially being treated with functional bracing for closed humeral shaft fractures and describe what factors are associated with this complication.

Materials and methods

This was a retrospective case series performed at three level 1 trauma centers across North America. All nonoperatively treated humeral shaft fractures were reviewed from 2001 to 2023. Patients were included if they sustained a humeral shaft fracture, > 18 years old, were initially treated non-operatively with functional bracing which subsequently converted to an open fracture. Eight patients met inclusion criteria. All included patients were eventually treated with irrigation, debridement, and open reduction and internal fixation. Outcomes assessed included mortality rate, time until the fracture converted from closed to open, need for further surgery, and bony union. Descriptive statistics were used in analysis.

Results

The eight included patients on average were 65 ± 21.4 years old and had a body mass index (BMI) of 25.6 ± 5.2. Six patients were initially injured due to a fall. Time until the fractures became open on average was 5.2 ± 3.6 weeks. Three patients (37.5%) died within 1.8 ± 0.6 years after initial injury. The average Charlson Comorbidity Index (CCI) score was 4.5 ± 3.4. Three patients (37.5%) had dementia. Common characteristics among this cohort included a history of visual disturbances (50.0%), cerebrovascular accident (50.0%), smoking (50.0%), and alcohol abuse (50.0%).

Conclusion

Conversion from a closed to open humeral shaft fracture after functional bracing is a potentially devastating complication. Physicians should be especially cognizant of patients with a low BMI, history of falling or visual disturbance, dementia, age ≥ 65, decreased sensorimotor protection, and significant smoking or alcohol history when choosing to use functional bracing as the final treatment modality.

Level of Evidence: IV.

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Data availability

Data is not available in a repository. All data used in analysis can be found in this manuscript.

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, MN, USA

    Stephen A. Doxey, Julie A. Switzer, Brian P. Cunningham & Chad M. Myeroff

  2. Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, 6500 Excelsior Boulevard, St. Louis Park, MN, 55426, USA

    Stephen A. Doxey, Julie A. Switzer & Brian P. Cunningham

  3. Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Megan M. Sorich

  4. Department of Orthopaedic Surgery, Regions Hospital, St. Paul, MN, USA

    Sarah C. Abraham & Chad M. Myeroff

  5. Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA

    Michael D. McKee

  6. Department of Orthopaedic Surgery, Banner University Medical Center, Phoenix, AZ, USA

    Michael D. McKee

Authors
  1. Stephen A. Doxey
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  2. Megan M. Sorich
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  3. Sarah C. Abraham
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  7. Chad M. Myeroff
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Contributions

All authors included on this manuscript have made significant contributions to this manuscript. Stephen A. Doxey contributed to conceptualization, methodology, validation, formal analysis, data curation, writing of the original draft and reviewing/editing and visualization. Megan M. Sorich contributed to conceptualization, methodology, validation, formal analysis, data curation, writing of the original draft and reviewing/editing and visualization. Sarah C. Abraham contributed to investigation, data curation, writing of the original draft and reviewing/editing the draft. Julie A. Switzer contributed to conceptualization, validation, data curation, writing of the original draft and reviewing/editing the draft. Brian P. Cunningham contributed to conceptualization, methodology, writing of the original draft and reviewing/editing, visualization, supervision and project administration. Michael D. McKee contributed to conceptualization, methodology, validation, data curation, writing of the original draft and reviewing/editing visualization, supervision and project administration. Chad M. Myeroff contributed to conceptualization, methodology, validation, data curation, writing of the original draft and reviewing/editing visualization, supervision and project administration.

Corresponding author

Correspondence to Brian P. Cunningham.

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Ethical approval

Prior to data collection, the local institutional review board determined this study to be exempt from ethical approval.

Conflicts of interest

Dr. Cunningham’s spouse is the CEO and founder of CODE Technology. Dr. Cunningham is a member of the AAOS Health Care Systems and Patient-reported Outcome Measures Committees as well as the chair of the OTA Practice Management Committee. He is also a member of the editorial board for the Journal of Orthopaedic Business. Dr. Switzer is committee member for AAOS and AOA. She is also on the editorial board for GOS&R, and a committee member for IGFS. Dr. McKee is a paid consultant for Acumed, Bioventus, Exactech, ITS, MY01 Inc., and Stryker. He is a board member for the Canadian Orthopaedic Association, Journal of Orthopaedics and Traumatology, Orthopaedic Trauma Association, and Orthopedics Today. Additionally, he receives royalties from Elsevier Inc, Springer, and Wolters Kluwer Health. For the remaining authors none were declared.

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Doxey, S.A., Sorich, M.M., Abraham, S.C. et al. Iatrogenic open humeral shaft fractures following functional bracing. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05369-4

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  • DOI: https://doi.org/10.1007/s00402-024-05369-4

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