ArticleBone & joint open2022
Routine fixation of humeral shaft fractures is cost-effective : cost-utility analysis of 215 patients at a mean of five years following nonoperative management.
Article in Bone & joint open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
8 citing papers in PubMed, 9 citations in OpenAlex.
- Cost-Effectiveness of Surgery Versus Functional Bracing for Humeral Shaft Fractures in Adults: A Prespecified Economic Evaluation of the Finnish Shaft of the Humerus (FISH) Trial.The Journal of bone and joint surgery. American volume · 2026Trial
- An Acta Orthopaedica educational article: Treatment of adult patients with a humeral shaft fracture.Acta orthopaedica · 2026Review
- Cost effectiveness analysis of operative versus nonoperative management of humeral shaft fractures in Denmark.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2025Article
- Chest wall soft tissue thickness is associated with humeral shaft non-union: A radiographic study.Shoulder & elbow · 2024Article
- A retrospective analysis of functional and radiographic outcomes of humeral shaft fractures treated operatively versus nonoperatively.JSES international · 2024Article
- Medial minimally invasive percutaneous plate osteosynthesis for humeral shaft fractures: a case series and novel technique description.Archives of orthopaedic and trauma surgery · 2023Article
- Medial minimally invasive plate osteosynthesis for humeral shaft fractures: a case series.Annals of medicine and surgery (2012) · 2023Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsThe primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion.
methodsFrom 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective.
resultsAt a mean of 5.4 yrs (1.2 to 11.0), the mean EQ-5D-3L was 0.736 (95% confidence interval (CI) 0.697 to 0.775). Adjusted analysis demonstrated the EQ-5D-3L was inferior among patients who united after nonunion surgery (β = 0.103; p = 0.032). Offering routine fixation to all patients to reduce the rate of nonunion would be associated with increased treatment costs of £1,542/patient, but would confer a potential EQ-5D-3L benefit of 0.120/patient over the study period. The ICER of routine fixation was £12,850/QALY gained. Selective fixation based on a RUSHU < 8 at six weeks post-injury would be associated with reduced treatment costs (£415/patient), and would confer a potential EQ-5D-3L benefit of 0.335 per 'at-risk patient'.
conclusionRoutine fixation for patients with humeral shaft fractures to reduce the rate of nonunion observed after nonoperative management appears to be a cost-effective intervention at five years post-injury. Selective fixation for patients at risk of nonunion based on their RUSHU may confer even greater cost-effectiveness, given the potential savings and improvement in health-related quality of life. Cite this article:
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