Abstract
BackgroundThe treatment of humeral fractures remains controversial. Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. However, it appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing.MethodsThis work is a cohort retrospective study in addition to the application of a questionnaire for self-rated quality of life with its 05 domains (WORC - Western Ontario Rotator Cuff Index) for patients (N = 26) classified in the Trauma Sector of the Department of Orthopedics and Traumatology of the Federal University of São Paulo (DOT/UNIFESP) submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing. There was also the inclusion of data related to the time since surgery, age, sex, surgical laterality, dominance among members and work leave, which were not considered in the original protocol. After, the data were statistically assessed to evaluate the association between numerical and categorical variables.ResultsThe overall WORC score was 82.75 ± 17.00 (Mean ± SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score than those who had the surgery on the non-dominant side. Although non-significant again, those who were away from work had an overall lower quality of life score than those who were not.ConclusionsThe WORC Quality of Life Protocol shows good results for evaluating patients submitted to humerus osteosynthesis with antegrade locked intramedullary nailing. The data stratified by domains were good, however, Work and Sport/Recreation domains showed the lowest means compared to the other domains.Trial registrationResearch Ethics Commitee (CEP 0676/2016) and Plataforma Brasil 56381216.3.0000.550. CAAE: 56381216.3.0000.5505.
Highlights
The treatment of humeral fractures remains controversial
The objective of this work was to do a follow up in patients that were submitted to surgeries through humeral fractures fixation using locked antegrade intramedullary nailing for a minimum of 6 months, using the Western Ontario Rotator Cuff Index (WORC) Quality of Life Protocol to gather data aiming for a better understanding of patients’ well being after the surgery
A retrospective review of patients cataloged in the Department of Traumatology (DOT) / UNIFESP, Department of Orthopedics and Traumatology of the Federal University of São Paulo (Brazil) submitted to Humerus Osteosynthesis using Locked Intramedullary Nailing with antegrade access was performed
Summary
Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. It appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing. According to Schmidutz et al [7], the evaluation and interpretation of shoulder and upper limb injuries is controversial and subjective, and should be considered beyond the clinical examination Subjective variables such as emotional aspects, sports, recreation or motivational habits of each patient should be interpreted differently
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