Estudio clínico comparativo entre la osteosíntesis con clavo intramedular bloqueado y osteosíntesis con placa y tornillos en el tratamiento de las fracturas de la diáfisis del humero

Abstract

Introduction: Humeral Shaft Fractures (HSF) are common findings in adults. Many authors considered that conservative treatment was the “Gold Standard” for their treatment, however, as a consequence of advances in technique and materials, surgical treatment has been gradually preferred, despite the fact that many related factors concerning bone healing, remain to be defined. The two surgical techniques most used at present to treat HSF are open osteosynthesis with plate and screws and osteosynthesis with a blocked intramedullary nail, by the antegrade route, although this is still a controversial choice and is a subject of debate among specialists. Hypothesis and Objectives: Our working hypothesis has been: Do patients HSF operated on by means of open osteosynthesis with plate and screws present inferior functional results, at 6 and 12 months postoperatively, ¿Relatively to patients with HSF operated by means of closed osteosynthesis with a blocked intramedullary nail? In order to respond to this hypothesis, we propose, as the general objective of the study, to demonstrate the difference in quality of life and functional capacity between patients with HSF who underwent osteosynthesis with plate and screws compared to patients with HSF who underwent osteosynthesis with a blocked intramedullary nail. As specific objectives, we consider whether consolidation, metabolic syndrome and addictive risk behaviors influence functional results in patients with HSF undergoing osteosynthesis, with plates and screws or with intramedullary nail. Patients and Methods: An observational, descriptive and prospective study was designed in patients with a diagnosis of HSF, who underwent osteosynthesis with plate and screws or osteosynthesis with a locked intramedullary nail at the Unidade Local de Saúde do Baixo Alentejo (Beja - Portugal), between October 2018 and December 2019. During the aforementioned period of time, 33 HSF were operated on in said hospital: 17 underwent osteosynthesis with a locked intramedullary nail and 16 to osteosynthesis with plate and screws. Results: The quality of life and functional capacity did not show statistically significant results between the two types of treatments performed, according to the PROMs (ASES, UCLA and Oxford) at 6 and 12 months postoperatively. Statistically significant differences have been observed in the ASES (6 and 12 months postoperative) of the patients who obtained consolidation of the HSF at 3 months compared to those who have achieved it at 6 and 12 months, with better results for the former. Patients with Metabolic Syndrome had lower scores in the PROMs at 6 months postoperatively and the Oxford at 12 months postoperatively, with respect to patients without Metabolic Syndrome. Metabolic syndrome is a positive predictive factor for obtaining worse postsurgical functional results. Conclusions: The results obtained allow us to propose the control of the factors that constitute the Metabolic Syndrome in the perioperative period in an attempt to achieve better functional results at 6 and 12 months postoperatively. Since there are no statistically significant differences in the PROMs of the two groups and, according to our results, the choice of fixation with plate and screws is recommended for more complex fractures, according to the AO classification, and the choice of fixation with a locked intramedullary nail for less complex fractures, to increase the probability of union at 3 months. And, therefore, they allow us to elevate our Hypothesis to the category of Thesis, stating that “Patients with a Humeral Shaft Fractures who underwent open osteosynthesis with a plate and screws present functional results at 6 and 12 months postoperatively similar to those who underwent closed osteosynthesis with a locked intramedullary nail”. The "Metabolic Syndrome" and the "Consolidation Time greater than 3 months" are significant factors to consider this type of patient.