A Protocol for the Conduct of a Multicentre, Prospective, Randomized Superiority Trial of Surgical Versus Non-surgical Interventions for Humeral Shaft Fractures

Overview

Journal Bone Jt Open

Date 2024 Apr 21

PMID 38643977

Authors

Marloes Franssen

Juul Achten

Duncan Appelbe

Matthew L Costa

Susan Dutton

James Mason

Jenny Gould

Andrew Gray

Amar Rangan

Warren Sheehan

Harvinder Singh

Stephen E Gwilym

Affiliations

Soon will be listed here.

Abstract

Aims: Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures.

Methods: The HUmeral SHaft (HUSH) fracture study is a multicentre, prospective randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures in adult patients. Participants will be randomized to receive either functional bracing or surgery. With 334 participants, the trial will have 90% power to detect a clinically important difference for the Disabilities of the Arm, Shoulder and Hand questionnaire score, assuming 20% loss to follow-up. Secondary outcomes will include function, pain, quality of life, complications, cost-effectiveness, time off work, and ability to drive.

Discussion: The results of this trial will provide evidence regarding clinical and cost-effectiveness between surgical and non-surgical treatment of humeral shaft fractures. Ethical approval has been obtained from East of England - Cambridge Central Research Ethics Committee. Publication is anticipated to occur in 2024.

Citing Articles

Outcomes of Intramedullary Nailing Versus Plate Fixation in the Management of Humeral Shaft Fractures: A Systematic Review and Meta-Analysis.

Nadeem A, Abbasi H Cureus. 2024; 16(10):e72473.

PMID: 39469277 PMC: 11514719. DOI: 10.7759/cureus.72473.

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