Abstract
BackgroundHumeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace.Methods/DesignThis randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs.DiscussionAccording to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery).Trial registrationCurrent Controlled Trials: ISRCTN24835397
Highlights
According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures
According to current evidence from a systematic review [28], this study is one of the first randomised controlled trials designed to compare surgical to nonsurgical management of humeral shaft fractures, to evaluate outcomes of quality of life, safety and effectiveness
Despite the risk of a surgical intervention, the minimally invasive plate osteosynthesis technique seems to be reproducible and applicable in almost all types of humeral shaft fractures. It had the advantage of minimal soft tissue dissection and lower rates of iatrogenic nerve injury when compared to the conventional plate technique
Summary
Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, this method can present unsatisfactory results. There is no good quality evidence advocating which method is more effective This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace. Non-operative treatment is still the standard treatment for isolated humeral shaft fractures [6,7], this method can present unsatisfactory results, such as, nonunion and shoulder impairment [8,9]. Surgical options for treatment of humeral shaft fractures include open reduction and internal fixation with a compression plate, intramedullary nail osteosysthesis and minimally invasive bridge plate fixation. Open reduction and rigid internal fixation with absolute stability using dynamic compression plates [17,18,19] is today’s standard and is the more common surgical option for treatment of these fractures
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