Fracture type, treatment, and outcome of humeral shaft fractures in polytraumatized patients: a case series

Abstract

Since most clinical studies on humeral shaft fractures exclude polytraumatized patients, the epidemiology in this population is largely unknown. The aim of this study was to describe the fracture type, treatment, and outcome of humeral shaft fractures in adult polytraumatized patients. A case series with a single follow-up questionnaire was performed in patients aged 16 years or older with a humeral shaft fracture and an injury severity score of 16 or higher, admitted to a level 1 trauma center between January 1, 2007, and July 31, 2021. Details on injuries, treatment, and clinical outcome were collected from the national trauma registry and medical records. Patients were asked to complete the Disabilities of the Arm, Shoulder, and Hand (DASH), EuroQol-5D (EQ-5D), and Short Form-36 (SF- 36). Twenty-nine patients were included. The median age was 41 years and 18 (62%) were male. Most fractures were type A (N=19; 66%). Most patients were treated operatively (N=26; 90%) within three days. Radial nerve palsy at presentation was reported in five (20%) patients. Infection occurred in one (4%) patient and nonunion in six (27%) patients. The patient-reported outcome measures were as follows (median; quartiles): DASH (20.0; P25-P75 5.6-35.2), EQ utility (0.75; P25-P75 0.58-0.88) and visual analog score (0.80; P25-P75 71-95), SF-36 physical (49; P25-P75 43- 55) and mental component summary (58; P25-P75 47-61). Humeral shaft fractures in adult polytraumatized patients were most often AO-type A and treated operatively. Radial nerve palsy at presentation and nonunion rates were high. Patients still reported upper extremity disability at approximately five years post trauma.

Level of evidence: Prognosis study Level IV: Case series.