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Scoring of radiographic cortical healing with the radiographic humerus union measurement predicts union in humeral shaft fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to determine if the radiographic humerus union measurement (RHUM) is predictive of union in humeral shaft fractures treated nonoperatively.

Methods

All patients with long bone fracture nonunion presenting to a single surgeon were enrolled in a prospective registry. This registry was queried to identify patients with humeral shaft fractures treated nonoperatively and developed nonunion. The nonunion cohort was matched to a three to one gender- and age-matched control group that were treated nonoperatively for a humeral shaft fracture and achieved union. Two fellowship-trained orthopedic traumatologists blinded to eventual union scored radiographs obtained 12 weeks after injury using the RHUM. A binomial logistic regression determined the effect of the RHUM on the likelihood of developing union.

Results

Nine patients with humeral shaft fractures treated nonoperatively with radiographs 12 weeks after injury that developed nonunion were identified. These patients were matched to 27 controls. Logistic regression demonstrated the RHUM was a significant predictor of healing 12 weeks after humeral shaft fracture treated nonoperatively (p = 0.014, odds ratio 9.434, 95% CI for OR 1.586–56.098). All patients with RHUM below 7 went on to nonunion. All patients with RHUM above 8 healed. Three of seven patients (43%) with RHUM of 7 or 8 healed.

Conclusion

The RHUM demonstrated an increased likelihood of achieving union 12 weeks after injury. Orthopedic surgeons can counsel patients that fractures with RHUM scores of 6 or below are in danger of developing nonunion and can target interventions appropriately.

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Funding

Funding

No sources of funding were obtained for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mount Sinai Health System, 5 E. 98th Street, Box 1188, New York, NY, 10029-6504, USA

    Anthony V. Christiano

  2. NYU Langone Medical Center, New York, NY, USA

    Christian A. Pean, Philipp Leucht, Sanjit R. Konda & Kenneth A. Egol

Authors
  1. Anthony V. Christiano
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  2. Christian A. Pean
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  3. Philipp Leucht
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  4. Sanjit R. Konda
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  5. Kenneth A. Egol
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Anthony Christiano, Christian Pean and Sanjit Konda. The first draft of the manuscript was written by Anthony Christiano, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Anthony V. Christiano.

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The authors report no conflict of interest or sources of funding related to the contents of the manuscript.

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Our study was approved by the appropriate institutional research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Christiano, A.V., Pean, C.A., Leucht, P. et al. Scoring of radiographic cortical healing with the radiographic humerus union measurement predicts union in humeral shaft fractures. Eur J Orthop Surg Traumatol 30, 835–838 (2020). https://doi.org/10.1007/s00590-020-02635-0

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  • DOI: https://doi.org/10.1007/s00590-020-02635-0

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