Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management
Abstract. Objectives:. To describe operative results after humerus nonunion surgery in patients whose initial humerus shaft fracture (OTA/AO code 12) was treated nonoperatively and to identify risk factors of nonunion surgery failure in the same population. Design:. Case series. Setting:. Nine acade...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-03-01
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| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000354 |
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| author | Alexander Hysong, MD Noah Harrison, MD Samuel Posey, MD Ziqing Yu, MS Andrew T. Chen, MD Patrick Pallitto, MD Joseph R. Hsu, MD William Obremskey, MD Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT) Hassan Mir, MD Roman M. Natoli, MD, PhD Ishani Sharma, MD, MBA Jenna Jones, Med Luke A. Lopas, MD Hassan Farooq, MD Robert D. Zura, MD Alexander Padovano, MD Nathaniel Koutlas, MD Steve Hemmerly, BS Elsa Rodriguez, MD Daniel E. Pereira, MD Sharon Babcock, MD Gabriel James Sowards, BS Martha Holden, AAS, AA Anna N. Miller, MD Marc Schatz, MD Jessica Rivera, MD, PhD Katrina Bang, MD Kamryn King, BS Zachery Hong, BA Jarrod Dumpe, MD Gabriella Lea Stribling, BS Merritt John Thompson, MD Tracy Johns, MSN, RN-BC Rachel Seymour, PhD Susan Odum, PhD Stephen Sims, MD Olivia Rice, MD Ainsley Bloomer, MD Katheryn Peterson, BSPH Amber Stanley, BSPH Mario Cuadra, MD Gisele Bailey, MS Matthew Braswell, MD Landon Bulloch, MD William Haynes, MD Josef Jolissaint, MD Julia Mastracci, MD Andrew Wohler, MD Eddie Komie Afetse, BS, BA Cara Girardi Juliette Sweeney, BS Benjamin Averkamp, MD Meghan Wally, PhD Madhav Karunakar, MD Kevin Phelps, MD Laurence Kempton, MD Christine Churchill, MA, CCRP David Macknet, MD Hannah Pollock, BS Rodney Arthur, MS Samuel Cohen-Tanugi Isaac Boateng James Michael Ruth, BS Joseph Michalski, MD Anna Hemminger, BS Kathryn Leighty Mir Ibrahim Sajid, MD Thea Lance, BA William Hunter Waddell, MD Andres Fidel Moreno Diaz, MD Joseph Gutbrod, BS Christopher G. Herbosa, BS |
| author_facet | Alexander Hysong, MD Noah Harrison, MD Samuel Posey, MD Ziqing Yu, MS Andrew T. Chen, MD Patrick Pallitto, MD Joseph R. Hsu, MD William Obremskey, MD Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT) Hassan Mir, MD Roman M. Natoli, MD, PhD Ishani Sharma, MD, MBA Jenna Jones, Med Luke A. Lopas, MD Hassan Farooq, MD Robert D. Zura, MD Alexander Padovano, MD Nathaniel Koutlas, MD Steve Hemmerly, BS Elsa Rodriguez, MD Daniel E. Pereira, MD Sharon Babcock, MD Gabriel James Sowards, BS Martha Holden, AAS, AA Anna N. Miller, MD Marc Schatz, MD Jessica Rivera, MD, PhD Katrina Bang, MD Kamryn King, BS Zachery Hong, BA Jarrod Dumpe, MD Gabriella Lea Stribling, BS Merritt John Thompson, MD Tracy Johns, MSN, RN-BC Rachel Seymour, PhD Susan Odum, PhD Stephen Sims, MD Olivia Rice, MD Ainsley Bloomer, MD Katheryn Peterson, BSPH Amber Stanley, BSPH Mario Cuadra, MD Gisele Bailey, MS Matthew Braswell, MD Landon Bulloch, MD William Haynes, MD Josef Jolissaint, MD Julia Mastracci, MD Andrew Wohler, MD Eddie Komie Afetse, BS, BA Cara Girardi Juliette Sweeney, BS Benjamin Averkamp, MD Meghan Wally, PhD Madhav Karunakar, MD Kevin Phelps, MD Laurence Kempton, MD Christine Churchill, MA, CCRP David Macknet, MD Hannah Pollock, BS Rodney Arthur, MS Samuel Cohen-Tanugi Isaac Boateng James Michael Ruth, BS Joseph Michalski, MD Anna Hemminger, BS Kathryn Leighty Mir Ibrahim Sajid, MD Thea Lance, BA William Hunter Waddell, MD Andres Fidel Moreno Diaz, MD Joseph Gutbrod, BS Christopher G. Herbosa, BS |
| author_sort | Alexander Hysong, MD |
| collection | DOAJ |
| description | Abstract. Objectives:. To describe operative results after humerus nonunion surgery in patients whose initial humerus shaft fracture (OTA/AO code 12) was treated nonoperatively and to identify risk factors of nonunion surgery failure in the same population.
Design:. Case series.
Setting:. Nine academic level 1 trauma centers.
Patients/Participants:. One hundred twenty patients with humerus nonunion whose initial fracture was treated nonoperatively.
Intervention:. Operative treatment of humerus nonunions.
Main Outcome Measurements:. Rate of recalcitrant nonunion after humerus nonunion surgery.
Results:. Of 108 humerus nonunions, 26 (24.07%) failed to unite after nonunion surgery. Moreover, 34 patients (31.48%) experienced 1 or more postoperative complications. Multivariate analysis found that the use of bone graft or bone graft substitute was not associated with successful nonunion surgery (95% odds ratio confidence interval [CI] [0.67–5.3], P = 0.23). Tobacco use was associated with an increased risk of persistent nonunion (P = 0.0041). Postoperative complications (P = 0.0001) were also associated with an increased risk of persistent nonunion. Diabetes and open fracture were not associated with differences in the nonunion repair success rate.
Conclusions:. As the largest and most generalizable to date, this multicenter study found that nearly 1 in 4 patients with a humeral nonunion after initial nonoperative management failed their nonunion surgical treatment. While postoperative complications were associated with recalcitrant nonunion, surgical adjuncts such as bone grafting and type did not seem to influence the success rate of nonunion surgery. Smoking is a modifiable risk factor suggesting that smoking cessation should be part of the intervention. These findings can be used to give patients and surgeons a realistic expectation of results and complications after humerus nonunion surgery.
Level of Evidence:. Therapeutic level III. |
| format | Article |
| id | doaj-art-f952893b66714daa9acb4f51aa8c2293 |
| institution | Kabale University |
| issn | 2574-2167 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj-art-f952893b66714daa9acb4f51aa8c22932025-01-24T09:20:31ZengWolters KluwerOTA International2574-21672025-03-018110.1097/OI9.0000000000000354OI90000000000000354Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative managementAlexander Hysong, MD0Noah Harrison, MD1Samuel Posey, MD2Ziqing Yu, MS3Andrew T. Chen, MD4Patrick Pallitto, MD5Joseph R. Hsu, MD6William Obremskey, MD7Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT)Hassan Mir, MDRoman M. Natoli, MD, PhDIshani Sharma, MD, MBAJenna Jones, MedLuke A. Lopas, MDHassan Farooq, MDRobert D. Zura, MDAlexander Padovano, MDNathaniel Koutlas, MDSteve Hemmerly, BSElsa Rodriguez, MDDaniel E. Pereira, MDSharon Babcock, MDGabriel James Sowards, BSMartha Holden, AAS, AAAnna N. Miller, MDMarc Schatz, MDJessica Rivera, MD, PhDKatrina Bang, MDKamryn King, BSZachery Hong, BAJarrod Dumpe, MDGabriella Lea Stribling, BSMerritt John Thompson, MDTracy Johns, MSN, RN-BCRachel Seymour, PhDSusan Odum, PhDStephen Sims, MDOlivia Rice, MDAinsley Bloomer, MDKatheryn Peterson, BSPHAmber Stanley, BSPHMario Cuadra, MDGisele Bailey, MSMatthew Braswell, MDLandon Bulloch, MDWilliam Haynes, MDJosef Jolissaint, MDJulia Mastracci, MDAndrew Wohler, MDEddie Komie Afetse, BS, BACara GirardiJuliette Sweeney, BSBenjamin Averkamp, MDMeghan Wally, PhDMadhav Karunakar, MDKevin Phelps, MDLaurence Kempton, MDChristine Churchill, MA, CCRPDavid Macknet, MDHannah Pollock, BSRodney Arthur, MSSamuel Cohen-TanugiIsaac BoatengJames Michael Ruth, BSJoseph Michalski, MDAnna Hemminger, BSKathryn LeightyMir Ibrahim Sajid, MDThea Lance, BAWilliam Hunter Waddell, MDAndres Fidel Moreno Diaz, MDJoseph Gutbrod, BSChristopher G. Herbosa, BSa Atrium Health Musculoskeletal Institute, Charlotte, NCa Atrium Health Musculoskeletal Institute, Charlotte, NCa Atrium Health Musculoskeletal Institute, Charlotte, NCa Atrium Health Musculoskeletal Institute, Charlotte, NCb University of North Carolina, Chapel Hill, NCb University of North Carolina, Chapel Hill, NCa Atrium Health Musculoskeletal Institute, Charlotte, NCc Vanderbilt University Medical Center, Nashville, TN.Abstract. Objectives:. To describe operative results after humerus nonunion surgery in patients whose initial humerus shaft fracture (OTA/AO code 12) was treated nonoperatively and to identify risk factors of nonunion surgery failure in the same population. Design:. Case series. Setting:. Nine academic level 1 trauma centers. Patients/Participants:. One hundred twenty patients with humerus nonunion whose initial fracture was treated nonoperatively. Intervention:. Operative treatment of humerus nonunions. Main Outcome Measurements:. Rate of recalcitrant nonunion after humerus nonunion surgery. Results:. Of 108 humerus nonunions, 26 (24.07%) failed to unite after nonunion surgery. Moreover, 34 patients (31.48%) experienced 1 or more postoperative complications. Multivariate analysis found that the use of bone graft or bone graft substitute was not associated with successful nonunion surgery (95% odds ratio confidence interval [CI] [0.67–5.3], P = 0.23). Tobacco use was associated with an increased risk of persistent nonunion (P = 0.0041). Postoperative complications (P = 0.0001) were also associated with an increased risk of persistent nonunion. Diabetes and open fracture were not associated with differences in the nonunion repair success rate. Conclusions:. As the largest and most generalizable to date, this multicenter study found that nearly 1 in 4 patients with a humeral nonunion after initial nonoperative management failed their nonunion surgical treatment. While postoperative complications were associated with recalcitrant nonunion, surgical adjuncts such as bone grafting and type did not seem to influence the success rate of nonunion surgery. Smoking is a modifiable risk factor suggesting that smoking cessation should be part of the intervention. These findings can be used to give patients and surgeons a realistic expectation of results and complications after humerus nonunion surgery. Level of Evidence:. Therapeutic level III.http://journals.lww.com/10.1097/OI9.0000000000000354 |
| spellingShingle | Alexander Hysong, MD Noah Harrison, MD Samuel Posey, MD Ziqing Yu, MS Andrew T. Chen, MD Patrick Pallitto, MD Joseph R. Hsu, MD William Obremskey, MD Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT) Hassan Mir, MD Roman M. Natoli, MD, PhD Ishani Sharma, MD, MBA Jenna Jones, Med Luke A. Lopas, MD Hassan Farooq, MD Robert D. Zura, MD Alexander Padovano, MD Nathaniel Koutlas, MD Steve Hemmerly, BS Elsa Rodriguez, MD Daniel E. Pereira, MD Sharon Babcock, MD Gabriel James Sowards, BS Martha Holden, AAS, AA Anna N. Miller, MD Marc Schatz, MD Jessica Rivera, MD, PhD Katrina Bang, MD Kamryn King, BS Zachery Hong, BA Jarrod Dumpe, MD Gabriella Lea Stribling, BS Merritt John Thompson, MD Tracy Johns, MSN, RN-BC Rachel Seymour, PhD Susan Odum, PhD Stephen Sims, MD Olivia Rice, MD Ainsley Bloomer, MD Katheryn Peterson, BSPH Amber Stanley, BSPH Mario Cuadra, MD Gisele Bailey, MS Matthew Braswell, MD Landon Bulloch, MD William Haynes, MD Josef Jolissaint, MD Julia Mastracci, MD Andrew Wohler, MD Eddie Komie Afetse, BS, BA Cara Girardi Juliette Sweeney, BS Benjamin Averkamp, MD Meghan Wally, PhD Madhav Karunakar, MD Kevin Phelps, MD Laurence Kempton, MD Christine Churchill, MA, CCRP David Macknet, MD Hannah Pollock, BS Rodney Arthur, MS Samuel Cohen-Tanugi Isaac Boateng James Michael Ruth, BS Joseph Michalski, MD Anna Hemminger, BS Kathryn Leighty Mir Ibrahim Sajid, MD Thea Lance, BA William Hunter Waddell, MD Andres Fidel Moreno Diaz, MD Joseph Gutbrod, BS Christopher G. Herbosa, BS Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management OTA International |
| title | Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| title_full | Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| title_fullStr | Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| title_full_unstemmed | Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| title_short | Factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| title_sort | factors associated with failure of humerus nonunion surgery in patients with initial nonoperative management |
| url | http://journals.lww.com/10.1097/OI9.0000000000000354 |
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