Surgical Interventions for the Treatment of Humeral Shaft Fractures

NCT ID: NCT02418260

Last Updated: 2017-10-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-06-30

Study Completion Date

2019-06-30

Brief Summary

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This study intends to determine the best surgical treatment for humeral shaft fractures. One third of the patients will be treated with open reduction and internal fixation with plate; one third, with bridge plate technique and the remaining third with locked intramedullary nail.

Detailed Description

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Humerus diaphyseal fractures are amongst the most common of the appendicular skeleton. Despite the fact that the conservative treatment is still the gold standard for the majority of these fractures, this method was not proven to be superior when compared to the surgical treatment. Surgical options for the treatment of humeral shaft fractures range from open reduction and internal fixation with plate to minimally invasive methods (bridge plate and intramedullary nail) and the best method has yet to be determined. The goal of this study is to determine the best surgical option for the treatment of humeral shaft fractures. For this, will be recruited 105 patients with humeral shaft fractures, wich will be allocated, randomly, in 3 distinct groups. Each patient will be submitted to one of three possible methods of humerus osteosynthesis: open reduction and internal fixation with plate (ORIF), closed reduction and fixation with bridge plate or closed reduction and fixation with intramedullary nail. All data will be paired according to the age, gender, fracture classification, patient comorbidities and smoking habit. The Pearson's chi-square" test will be used to analyze the results of the three groups regarding categorical variables, and Student t-test (parametric) will be used to compare groups with respect to the numerical variables. The investigators expect to conclude that the methods of minimally invasive osteosynthesis of humeral shaft fractures have similar or better functional and radiographic outcomes, compared to the method of open reduction and internal fixation with a plate, with lesser risk of complications and an earlier return to activities.

Conditions

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Fracture of Shaft of Humerus Humerus Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Open reduction and plate osteosynthesis

Open reduction and internal fixation with DCP 4.5mm plate.

Group Type ACTIVE_COMPARATOR

Open reduction and plate osteosynthesis

Intervention Type PROCEDURE

Trough an posterior or anterolateral approach, the fracture will be directly reduced and fixed with a broad DCP 4.5mm plate.

Bridge Plate

Patients will be submitted to closed reduction and anterior bridge plate osteosynthesis (narrow 4.5mm DCP plate will be used)

Group Type EXPERIMENTAL

Bridge Plate osteosynthesis

Intervention Type PROCEDURE

Trough two anterior skin incisions, the 4.5mm narrow DCP plate will be placed on the anterior surface of the humerus and, after indirect reduction, it will be fixed to the bone with 2 proximal and 2 distal screws.

Intramedullary nail

Patients will be submitted to closed reduction and locked intramedullary nail osteosynthesis.

Group Type EXPERIMENTAL

Locked intramedullary nail osteosynthesis

Intervention Type PROCEDURE

Trough an anterolateral approach to the shoulder, the supraspinatus tendon will be longitudinally splited allowing the insertion of the intramedullary nail.

Interventions

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Bridge Plate osteosynthesis

Trough two anterior skin incisions, the 4.5mm narrow DCP plate will be placed on the anterior surface of the humerus and, after indirect reduction, it will be fixed to the bone with 2 proximal and 2 distal screws.

Intervention Type PROCEDURE

Locked intramedullary nail osteosynthesis

Trough an anterolateral approach to the shoulder, the supraspinatus tendon will be longitudinally splited allowing the insertion of the intramedullary nail.

Intervention Type PROCEDURE

Open reduction and plate osteosynthesis

Trough an posterior or anterolateral approach, the fracture will be directly reduced and fixed with a broad DCP 4.5mm plate.

Intervention Type PROCEDURE

Other Intervention Names

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Bridge Plate IMN ORIF

Eligibility Criteria

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Inclusion Criteria

* Complete fracture with angulation greater than 20 degrees, rotation greater than 30 degrees and/or shortening greater than 3 cm.
* Fractures located from 4 cm distal to the surgical neck to 2 cm proximal to the end of the medullary canal.

Exclusion Criteria

* fractures older than 3 weeks
* pathologic fractures
* fractures with extension to elbow or shoulder joint
* patients with ipsilateral upper extremity fracture or injury
* fractures with associated neurologic injury
* patients with previous pathology of the shoulder, arm or elbow that cause pain or range of motion limitation
* patients who do not agree with the terms of the study
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Federal University of São Paulo

OTHER

Sponsor Role lead

Responsible Party

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Rafael Pierami

Rafael Pierami, M.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Rafael Pierami

Role: PRINCIPAL_INVESTIGATOR

Federal University of São Paulo

Locations

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Hand and Upper Limb Surgery Discipline

São Paulo, , Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Rafael Pierami, M.D.

Role: CONTACT

+5511982325308

Marcel JS Tamaoki, Ph.D.

Role: CONTACT

+5511941713337

Facility Contacts

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Rafael Pierami, M.D.

Role: primary

+5511982325308

Marcel JS Tamaoki, Ph.D.

Role: backup

+5511941713337

References

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MANN RJ, NEAL EG. FRACTURES OF THE SHAFT OF THE HUMERUS IN ADULTS. South Med J. 1965 Mar;58:264-8. doi: 10.1097/00007611-196503000-00002. No abstract available.

Reference Type BACKGROUND
PMID: 14261543 (View on PubMed)

Rose SH, Melton LJ 3rd, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop Relat Res. 1982 Aug;(168):24-30.

Reference Type BACKGROUND
PMID: 7105548 (View on PubMed)

McKee MD LS. Humeral Shaft Fractures. Rockwood and Green's Fractures in Adults. 7th ed. Philadelphia: Lippincot Williams & Wilkins; 2009

Reference Type BACKGROUND

Baumgaertel F, Buhl M, Rahn BA. Fracture healing in biological plate osteosynthesis. Injury. 1998;29 Suppl 3:C3-6. doi: 10.1016/s0020-1383(98)95002-1.

Reference Type BACKGROUND
PMID: 10341891 (View on PubMed)

Bhandari M, Guyatt GH, Swiontkowski MF. User's guide to the orthopaedic literature: how to use an article about a surgical therapy. J Bone Joint Surg Am. 2001 Jun;83(6):916-26. doi: 10.2106/00004623-200106000-00015. No abstract available.

Reference Type BACKGROUND
PMID: 11407801 (View on PubMed)

Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010 Jul;1(2):100-7. doi: 10.4103/0976-500X.72352. No abstract available.

Reference Type BACKGROUND
PMID: 21350618 (View on PubMed)

Solway S, Beaton, D.E., McConnell, S., & Bombardier, C. The DASH Outcome measure user's manual (2nd Edition). Institute for Work & Health. Toronto2002.

Reference Type BACKGROUND

Orfale AG, Araujo PM, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res. 2005 Feb;38(2):293-302. doi: 10.1590/s0100-879x2005000200018. Epub 2005 Feb 15.

Reference Type BACKGROUND
PMID: 15785841 (View on PubMed)

Flandry F, Hunt JP, Terry GC, Hughston JC. Analysis of subjective knee complaints using visual analog scales. Am J Sports Med. 1991 Mar-Apr;19(2):112-8. doi: 10.1177/036354659101900204.

Reference Type BACKGROUND
PMID: 2039061 (View on PubMed)

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987 Jan;(214):160-4.

Reference Type BACKGROUND
PMID: 3791738 (View on PubMed)

Balfour GW, Marrero CE. Fracture brace for the treatment of humerus shaft fractures caused by gunshot wounds. Orthop Clin North Am. 1995 Jan;26(1):55-63.

Reference Type RESULT
PMID: 7838503 (View on PubMed)

Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977 Jul;59(5):596-601.

Reference Type RESULT
PMID: 873955 (View on PubMed)

Ward EF SF, Hughes JL. Fractures of the diaphyseal humerus. In: Saunders, ed. Skeletal trauma: fractures, dislocation, ligamentous injuries. Philadelphia: Saunders; 1998:1523-47

Reference Type RESULT

Balfour GW, Mooney V, Ashby ME. Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg Am. 1982 Jan;64(1):11-3. No abstract available.

Reference Type RESULT
PMID: 7054192 (View on PubMed)

Amillo S, Barrios RH, Martinez-Peric R, Losada JI. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma. 1993;7(3):211-5. doi: 10.1097/00005131-199306000-00002.

Reference Type RESULT
PMID: 8326423 (View on PubMed)

Foster RJ, Swiontkowski MF, Bach AW, Sack JT. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg Am. 1993 Jan;18(1):121-4. doi: 10.1016/0363-5023(93)90255-2.

Reference Type RESULT
PMID: 8423295 (View on PubMed)

Pollock FH, Drake D, Bovill EG, Day L, Trafton PG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am. 1981 Feb;63(2):239-43.

Reference Type RESULT
PMID: 7462281 (View on PubMed)

Ekholm R, Tidermark J, Tornkvist H, Adami J, Ponzer S. Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma. 2006 Oct;20(9):591-6. doi: 10.1097/01.bot.0000246466.01287.04.

Reference Type RESULT
PMID: 17088659 (View on PubMed)

Rutgers M, Ring D. Treatment of diaphyseal fractures of the humerus using a functional brace. J Orthop Trauma. 2006 Oct;20(9):597-601. doi: 10.1097/01.bot.0000249423.48074.82.

Reference Type RESULT
PMID: 17088660 (View on PubMed)

Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006 Nov;88(11):2343-7. doi: 10.2106/JBJS.F.00334.

Reference Type RESULT
PMID: 17079389 (View on PubMed)

Gosler MW, Testroote M, Morrenhof JW, Janzing HM. Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD008832. doi: 10.1002/14651858.CD008832.pub2.

Reference Type RESULT
PMID: 22258990 (View on PubMed)

Papasoulis E, Drosos GI, Ververidis AN, Verettas DA. Functional bracing of humeral shaft fractures. A review of clinical studies. Injury. 2010 Jul;41(7):e21-27. doi: 10.1016/j.injury.2009.05.004. Epub 2009 Jun 11.

Reference Type RESULT
PMID: 19523625 (View on PubMed)

Zagorski JB, Latta LL, Zych GA, Finnieston AR. Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am. 1988 Apr;70(4):607-10.

Reference Type RESULT
PMID: 3356728 (View on PubMed)

Wallny T, Westermann K, Sagebiel C, Reimer M, Wagner UA. Functional treatment of humeral shaft fractures: indications and results. J Orthop Trauma. 1997 May;11(4):283-7. doi: 10.1097/00005131-199705000-00011.

Reference Type RESULT
PMID: 9258827 (View on PubMed)

Fjalestad T, Stromsoe K, Salvesen P, Rostad B. Functional results of braced humeral diaphyseal fractures: why do 38% lose external rotation of the shoulder? Arch Orthop Trauma Surg. 2000;120(5-6):281-5. doi: 10.1007/s004020050465.

Reference Type RESULT
PMID: 10853896 (View on PubMed)

Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):143-50. doi: 10.1067/mse.2002.121634.

Reference Type RESULT
PMID: 11988725 (View on PubMed)

Ricciardi-Pollini PT, Falez F. The treatment of diaphyseal fractures by functional bracing. Results in 36 cases. Ital J Orthop Traumatol. 1985 Jun;11(2):199-205.

Reference Type RESULT
PMID: 4066292 (View on PubMed)

Persad IJ, Kommu S. U cast or functional bracing following fractures of the shaft of humerus. Emerg Med J. 2007 May;24(5):361. doi: 10.1136/emj.2007.048504. No abstract available.

Reference Type RESULT
PMID: 17452711 (View on PubMed)

Wallny T, Sagebiel C, Westerman K, Wagner UA, Reimer M. Comparative results of bracing and interlocking nailing in the treatment of humeral shaft fractures. Int Orthop. 1997;21(6):374-9. doi: 10.1007/s002640050189.

Reference Type RESULT
PMID: 9498146 (View on PubMed)

Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br. 1985 Mar;67(2):293-6. doi: 10.1302/0301-620X.67B2.3980544.

Reference Type RESULT
PMID: 3980544 (View on PubMed)

Dabezies EJ, Banta CJ 2nd, Murphy CP, d'Ambrosia RD. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma. 1992;6(1):10-3.

Reference Type RESULT
PMID: 1556609 (View on PubMed)

Heim D, Herkert F, Hess P, Regazzoni P. Surgical treatment of humeral shaft fractures--the Basel experience. J Trauma. 1993 Aug;35(2):226-32.

Reference Type RESULT
PMID: 8355300 (View on PubMed)

Grass G, Kabir K, Ohse J, Rangger C, Besch L, Mathiak G. Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN). Open Orthop J. 2011;5:319-23. doi: 10.2174/1874325001105010319. Epub 2011 Aug 26.

Reference Type RESULT
PMID: 21915231 (View on PubMed)

Chao TC, Chou WY, Chung JC, Hsu CJ. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop. 2005 Apr;29(2):88-91. doi: 10.1007/s00264-004-0620-8. Epub 2005 Feb 16.

Reference Type RESULT
PMID: 15714304 (View on PubMed)

Ajmal M, O'Sullivan M, McCabe J, Curtin W. Antegrade locked intramedullary nailing in humeral shaft fractures. Injury. 2001 Nov;32(9):692-4. doi: 10.1016/s0020-1383(01)00076-6.

Reference Type RESULT
PMID: 11600115 (View on PubMed)

Petsatodes G, Karataglis D, Papadopoulos P, Christoforides J, Gigis J, Pournaras J. Antegrade interlocking nailing of humeral shaft fractures. J Orthop Sci. 2004;9(3):247-52. doi: 10.1007/s00776-004-0780-9.

Reference Type RESULT
PMID: 15168178 (View on PubMed)

Aksu N, Karaca S, Kara AN, Isiklar ZU. Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures. Acta Orthop Traumatol Turc. 2012;46(3):154-60. doi: 10.3944/aott.2012.2592.

Reference Type RESULT
PMID: 22659630 (View on PubMed)

Shetty MS, Kumar MA, Sujay K, Kini AR, Kanthi KG. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures. Indian J Orthop. 2011 Nov;45(6):520-6. doi: 10.4103/0019-5413.87123.

Reference Type RESULT
PMID: 22144745 (View on PubMed)

Ouyang H, Xiong J, Xiang P, Cui Z, Chen L, Yu B. Plate versus intramedullary nail fixation in the treatment of humeral shaft fractures: an updated meta-analysis. J Shoulder Elbow Surg. 2013 Mar;22(3):387-95. doi: 10.1016/j.jse.2012.06.007. Epub 2012 Sep 1.

Reference Type RESULT
PMID: 22947239 (View on PubMed)

Liu GD, Zhang QG, Ou S, Zhou LS, Fei J, Chen HW, Nan GX, Gu JW. Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures. Int J Surg. 2013;11(9):864-8. doi: 10.1016/j.ijsu.2013.08.002. Epub 2013 Aug 28.

Reference Type RESULT
PMID: 23994004 (View on PubMed)

Wang X, Chen Z, Shao Y, Ma Y, Fu D, Xia Q. A meta-analysis of plate fixation versus intramedullary nailing for humeral shaft fractures. J Orthop Sci. 2013 May;18(3):388-97. doi: 10.1007/s00776-013-0355-8. Epub 2013 Mar 8.

Reference Type RESULT
PMID: 23471713 (View on PubMed)

Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis. Acta Orthop. 2006 Apr;77(2):279-84. doi: 10.1080/17453670610046037.

Reference Type RESULT
PMID: 16752291 (View on PubMed)

Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. 2011 Jun 15;(6):CD005959. doi: 10.1002/14651858.CD005959.pub2.

Reference Type RESULT
PMID: 21678350 (View on PubMed)

Other Identifiers

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24997313.8.0000.5505

Identifier Type: -

Identifier Source: org_study_id