OBJECTIVES

: Intramedullary nailing (IMN) is a common procedure for patients with humeral fractures requiring surgery. The technology has been utilized for > 50 years and has shown favorable outcomes. This study evaluates patient characteristics associated with postoperative complications.

METHODS

A retrospective database analysis was conducted in the IBM® MarketScan® Commercial Database. Patients with humeral fractures during an inpatient admission with surgery requiring IMN (aka “Index”) between 2010-2018 were identified. Patient demographics, comorbidities at time of index repair procedure (31 Elixhauser comorbidity indices), fracture type (open vs closed), precise fracture anatomy and postoperative complication occurrence (compartment syndrome (CS), deep infection (DI), nonunion and mechanical complication (MC)) were identified for all cases. Kaplan-Meier survival analyses and Cox proportional hazard models were built for each complication type.

RESULTS

: 1,004 patients with humeral fractures requiring IMN were identified (mean age: 48.29 (standard deviation (SD): 15.73), 58.7% female). Orthopedic risk factors (osteoporosis, rheumatoid arthritis (RA) and obesity) were present in 16.8%, 3.5% and 15.3% patients, respectively. Most patients had some comorbidities at time of index (Elixhauser index: mean: 2.76 (SD: 2.42)). At 365-days, nonunion, CS, DI and MC rates reached 12.4% (95% confidence interval (CI): 10.0%-14.8%), 0.2% (95%CI: 0.0%-0.5%), 0.9% (95%CI: 0.2%-1.6%), 7.7% (95%CI: 5.8%-9.6%) respectively. None of the variables tested in the models were significant for CS, DI and MC due to the small population of patients with complications. Depression and age category 35-44 (vs 18-24) were significantly associated with risk of nonunion (Hazard Ratio: 1.88-95% confidence interval (CI):1.11-3.16 – p=0.018; 2.66-95%CI:1.16-6.12 – p=0.021).

CONCLUSIONS

: Nonunion was the most common complication following humeral fractures. Patient characteristics such as depression and age were associated with risk of complications.