A retrospective analysis of functional and radiographic outcomes of humeral shaft fractures treated operatively versus nonoperatively.

Background: To determine differences in functional outcomes, return to work, and complications, in operatively vs. nonoperatively treated diaphyseal humeral shaft fractures. Methods: 150 patients who presented to our center with a diaphyseal humeral shaft fracture (Orthopedic Trauma Association type 12) treated by open reduction internal fixation or closed reduction with bracing were retrospectively reviewed. Data collected included patient demographics, injury information, surgical details, and employment data. Clinical, radiographic, and patient-reported functional outcomes were recorded at routine standard-of-care follow-ups. Complications were recorded. Outcomes were analyzed using standard statistical methods and compared. Results: 150 patients with a mean 24.4 months of follow-up (12 to 60 months) were included for analysis. 83 (55.3%) patients were treated with nonoperative care in a functional brace. The rest were treated surgically. The mean time to healing did not differ between the cohorts (P > .05). Patients treated operatively recovered faster with regards to functional elbow range of motion by 6 weeks (P = .039), were more likely to be back at work by 8 weeks after injury (P = .001), and demonstrated earlier mean time to return-to-daily activities (P = .005). Incidence of nonunion was higher in the nonoperative cohort (10.84% vs. 0%, P = .031). Three (4.5%) patients in the operative group developed iatrogenic, postoperative nerve palsy. Two patients in the operative group (4%) had a superficial surgical site infection. Conclusion: More patients treated surgically had functional range of motion by 6 weeks. Functional gains should be weighed by the patient and surgeon against risk of surgery, nonunion, nerve injury, and infection when considering various treatment options to better accommodate patients' needs.

Is Postoperative Splinting Advantageous After Upper Extremity Fracture Surgery? Results From the Arm Splint Pain Improvement Research Experiment.

OBJECTIVES: The authors report no conflict of interest.To determine if short-term immobilization with a rigid long arm plaster elbow splint after surgery of the arm, elbow, or forearm results in superior outcomes compared with a soft dressing with early motion. DESIGN: Prospective Randomized Control Trial. SETTING: Academic Medical Center. PATIENT SELECTION CRITERIA: Patients undergoing operative treatment for a mid-diaphysis or distal humerus, elbow, or forearm fracture were consented and randomized according to the study protocol for postoperative application of a rigid elbow splint (10-14 days in a plaster Sugar Tong Splint for forearm fracture or a Long Arm plaster Splint for 10-14 for all others) or soft dressing and allowing immediate free range of elbow and wrist motion (range of motion [ROM]). OUTCOME MEASURES AND COMPARISONS: Self-reported pain (visual analog score or VAS), Healthscale (0-100, 100 denoting excellent health), and physical function (EuroQol 5 Dimension or EQ-5D) surveyed on postoperative days 1-5 and 14 were compared between groups. Patient-reported pain score (0-10, 10 denoting highest satisfaction) at week 6, time to fracture union, ultimate disabilities of the arm, shoulder, and hand score, and elbow ROM were also collected for analysis. Incidence of complications were assessed. RESULTS: Hundred patients (38 men to 62 women with a mean age of 55.7 years) were included. Over the first 5 days and again at postop day 14, the splint cohort reported a higher "Healthscale" from 0 to 100 than the nonsplint group on all study days ( P = 0.041). There was no difference in reported pain between the 2 study groups over the same interval ( P = 0.161 and 0.338 for least and worst pain, respectively), and both groups reported similar rates of treatment satisfaction ( P = 0.30). Physical function ( P = 0.67) and rates of wound problems ( P = 0.27) were similar. Additionally, the mean time to fracture healing was similar for the splint and control groups (4.6 ± 2.8 vs. 4.0 ± 2.2 months, P = 0.34). Ultimate elbow ROM was similar between the study groups ( P = 0.48, P = 0.49, P = 0.61, and P = 0.51 for elbow extension, flexion, pronation, and supination, respectively). CONCLUSIONS: Free range of elbow motion without splinting produced similar results compared with elbow immobilization after surgical intervention for a fracture to the humerus, elbow, and forearm. There was no difference in patient-reported pain outcomes, wound problems, or elbow ROM. Immobilized patients reported slightly higher "healthscale" ratings than nonsplinted patients and, however, reported similar rates of satisfaction. Both treatment strategies are acceptable after upper extremity fracture surgery. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Three-Dimensional Bioprinting in Orthopaedics.

Three-dimensional (3D)-printing technology has evolved dramatically in the last 30 years, from large machines with poor resolution to those with micron-level capabilities that sit on a desktop. This technology is being utilized in numerous medical applications, particularly in orthopaedic surgery. Over the past decade, technological advances have allowed for the application of this technology to the field of tissue engineering through the process of 3D bioprinting. Of interest to orthopaedic surgeons, active areas of research utilizing this technology involve the bioprinting of articular cartilage, bone, menisci, and intervertebral discs.