Comparison of results of conservative, intramedular nailing and plate osteosentesis treatment in humerus diaphysis fractures

We aimed to retrospectively evaluate and compare the results of inramedullary nailing, plaque osteosynthesis and conservative treatment in patients receiving humeral diaphyseal fractures in our clinic. Between January 2013 and February 2019, 79 patients who were treated conservatively, intramedullary nailing or plate osteosynthesis for humerus diaphyseal fractures were enrolled in the study at the Department of Orthopedics and Traumatology, Faculty of Medicine, Fırat University. Clinical, functional and radiological findings of the patients were evaluated retrospectively. Demographic data, duration of hospitalization, presence of additional trauma, radial nerve injury, nonunion, trauma type, smoking, fractured extremity side and fracture union time were evaluated. In addition, Stewart-Huntley and QuickDASH scoring criteria were used for functional evaluation. AO classification was used to determine fracture types. Of the 79 patients, 59 were male and 20 were female. The youngest of the patients included in the study were 16, the oldest was 83 years old and the mean age of the patients was 39.7 years. We evaluated the ages of the patients in 3 groups as 16-30, 30-60 and over 60 years. Etiological causes were traffic accidents in 33 patients (42%), simple falls in 33 patients (42%), gunshot wounds in 4 patients (5%), falls from height in 4 patients (5%) and work accident in 5 patients (6%) When the fractures were classified according to AO classification, 50 patients (63%) had AO type A, 15 patients (19%) AO type B, and 14 patients (18%) had AO type C fractures. Twety-three (29%) patients were treated with intamedullary nailing, 16 (20%) were treated conservatively, and 40 (51%) were treated with plaque osteosynthesis. Union was seen in 73 (92%) of 79 patients The patients were evaluated according to Stewart-Huntley and QuickDASH evaluation system. According to Stewart-Huntley scoring system, the rate of patients with excellent and good results was 74% in intramedullary nailing, 87% in conservative treatment and plate osteosynthesis. The relationship between three treatment methods and QuickDASH score was found to be significant. We used SPSS 22.0 (Statistical Packages for the Social Sciences) program to analyze our data. Categorical measurements were summarized as percentage and number, and continuous measurements were summarized as mean and standard deviation (median, minimum and maximum where necessary). Distribution control was used to evaluate continuous measurements between groups. When parametric distribution conditions were not fulfilled, Kruskal Wallis test and Mann Whitney U test were used. Chi square test or Fisher test statistics were used to compare categorical variables. Statistical significance was taken as 0,05 in all tests. As a result of the study; In patients with humeral diaphyseal fractures, high rates of union were obtained in 3 different treatment methods. The duration of hospitalization was shorter in conservatively treated patients. Decreased union time had positive effects on the functional results after the union. The duration of union was longer and nonunion rates were higher in smokers. Keywords: Humerus diaphyseal fracture, conservative treatment of humeral diaphyseal fracture, plate osteosynthesis of humerus diaphyseal fracture, intramedullary nailing of humerus diaphyseal fracture