Description
This presentation, led by William Oliver, addresses the topic of non-union prediction specifically related to humeral shaft fractures. Oliver begins by discussing the default nonoperative management approach to isolated closed humeral shaft fractures, despite evidence showing a significant complication rate of non-union (around 20%). He highlights that while surgical intervention for non-union is effective, it often results in poorer medium to long-term outcomes compared to successful initial management.
The speaker contrasts current practices, acknowledging the lower risk of non-union associated with plate fixation but notes that a universal application of surgery is not yet widely supported. Emphasis is placed on the importance of selectively targeting fixation for patients identified at high risk for non-union, introducing methods for identifying these patients early in their treatment phase. Oliver outlines multiple assessment strategies including baseline evaluations from presenting injury factors, delayed assessments, and imaging studies.
He discusses findings from a retrospective cohort study examining risk factors for non-union in humeral shaft fractures where pre-injury NSAID use and shoulder arthritis emerged as significant risks. However, he underscores the complexity in predicting non-union risk due to variations in findings across studies. Radiographic findings, particularly the gap between fracture fragments, are introduced as important diagnostic indicators, with specific attention given to a study indicating that each millimeter of gap increases non-union risk by 40%.
A scoring system named RUSHU, designed to quantify callus formation on x-rays, is presented as a promising tool for evaluating non-union risk based on radiographic assessments. The study reveals that a RUSHU score below 8 significantly correlates with increased odds of non-union, advocating for potential cost-saving benefits through a selective fixation approach based on this score. Finally, Oliver mentions ongoing research into the use of ultrasound as a supplementary tool for non-union prediction, sharing preliminary findings from a pilot study that suggests ultrasound could refine assessments, particularly in cases with ambiguous x-ray results.
The talk culminates in emphasizing the evolution towards integrating clinical mobility assessments and radiographic evaluations to enhance identification of patients at risk for non-union, ultimately aiming to improve patient outcomes.