Description
The presentation by Andrew Duckworth focuses on humerus fractures, specifically discussing the efficacy of primary fixation in treating these injuries. After acknowledging disclosures and introducing the next speaker, Duckworth highlights the nonunion rate associated with non-operative management, challenging conventional wisdom based on earlier literature. He emphasizes a significant nonunion rate of 18-20%, much higher than previously reported, and questions the validity of past studies advocating for non-operative approaches.
Duckworth presents a case study of a fit 58-year-old patient with a humerus fracture and engages the audience by asking for their preferred management approach. He critiques the disparity between surgical recommendations for patients versus personal choices of surgeons, pointing out the discomfort and inconvenience of brace-wearing during conservative management.
He further elaborates on the evolution of surgical techniques for humeral fractures, referencing a recent randomized controlled trial (RCT) showing that surgical intervention yields better early patient-reported outcomes, despite similar long-term results compared to non-operative management. Duckworth stresses the high nonunion rate with conservative treatment and discusses implications of nonunion on patient quality of life.
A meta-analysis of RCTs reveals that surgical fixation results in lower nonunion rates (less than 1% compared to 16% for non-operative methods), although surgery carries the risk of radial nerve palsy. He concludes that while early benefits of surgery are evident, the most crucial factor is the reduced likelihood of nonunion, suggesting that there is a potential for cost-effectiveness in adopting primary fixation strategies. Duckworth hints at future studies aimed at refining treatment guidelines, advocating for targeted surgical interventions to preemptively address nonunion risks.