A Randomised Controlled Trial Comparing Operative and Non-Operative Treatment of Humeral Diaphyseal Fractures

Description

This transcript captures a presentation given by Dr. Prism Schneider regarding a randomized controlled trial comparing surgical and non-surgical treatment options for humeral diaphyseal fractures. The session starts with an introduction by Michele Angers who outlines the significance of the research being presented. Dr. Schneider begins by thanking the Canadian Orthopedic Trauma Society for the opportunity to present, followed by disclosing the research team and their contributions.



The presentation discusses the study's background, revealing that historically, humeral diaphyseal fractures have been treated non-operatively, but with varying rates of nonunion reported up to 33%. The primary research question centers around whether operative treatment improves functional outcomes compared to non-operative treatment. To investigate this, a multicenter trial was conducted involving 180 adult patients treated across 12 sites in Canada. Exclusion criteria are highlighted, including open fractures and polytraumatized patients.



Dr. Schneider details the methodology, including randomization to either an operative (open reduction and internal fixation) or non-operative treatment, and outlines the patient follow-up and primary outcome measures, which include various patient-reported outcome scores.



Results from the trial are presented, showing statistically significant improvements in functional outcomes for those who underwent surgical treatment as compared to non-operative approaches, with particular emphasis on improvements in the DASH score and time to union.



The analysis extends to the demographic details of the cohort, the comparison of treatment outcomes, and an exploration of factors influencing recovery, including a notable finding that male patients reported better outcomes regardless of treatment type. The presentation concludes with discussions about the implications of these findings for clinical practice, offering insights into making informed decisions with patients regarding their treatments.

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