Conservative and surgical treatment evaluation of butterfly fragmented humerus shaft fractures

Objective: The aim of this study was investigating the effect of butterfly fragment in radiological and functional results of humeral fractures and nonunion treated by different methods. The reasons of clinical and radiological failure discussed to determine a more effective treatment plan.Method: This study is a cross-sectional research including patients diagnosed butterfly fragmented diaphyseal humerus fracture and followed-up in DEU Medical School Orthopedics and Traumatology Clinic in years 1998?2010. 56 patient?s demographic characteristics were recorded, X-rays were examined and QuickDASH Scale was administered for functional assessment. 45 of 56 patients functional assessment was made also by the Stewart-Hundley criteria. SPSS 16.0 for Windows statistical program is used for data evaluation and descriptive analysis, mean, median, standard derivation, chi-square, Kruskall Wallis and Mann-Whitney U tests. p<0.05 was considered statistically significant.Results: The mean age was 50.86±19.26. Patients were divided into three groups. The patients of Group 1 (14/56) were treated by conservative, Group 2 (29/56) by surgical methods successfully. Group 3 patients (13/57) were firstly treated conservative or surgical but nonunion occured. 48/56 of the butterfly fragment was settled medial. The mean of follow-up was 35.16±29.91 months. The follow-up of the groups were close but the functional assessment was poor significantly in Group 3 (p<0.05). Union rate was found 63.6% in conservative, 85.2% in surgically treated patients.Conclusion: Butterfly fragment has negative impact on humerus fracture treatment. Nonunion rates are high in conservative treatment. Geriatric population requires more attention. The union and functional results of plate osteosynthesis is superior to intramedullary nailing. Patient characteristics should be evaluated well in deciding surgical treatment. The fixation in surgical treatment should be traumatizing the butterfly fragment, the soft tissue and the circulation of the fracture minimum; nevertheless mechanically rigid and resistant to possible extended union period.Keywords: Humerus fracture, Butterfly fragment, QuickDASH scale.