A protocol for the conduct of a multicentre, prospective, randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures
M. Franssen, J. Achten, Duncan Appelbe, M. L. Costa, Susan J Dutton, James Mason, Jenny Gould, Andrew Gray, Amar Rangan, Warren Sheehan, Harvinder Singh, Steve Gwilym
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引用次数: 0
Abstract
Aims Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures. Methods The HUmeral SHaft (HUSH) fracture study is a multicentre, prospective randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures in adult patients. Participants will be randomized to receive either functional bracing or surgery. With 334 participants, the trial will have 90% power to detect a clinically important difference for the Disabilities of the Arm, Shoulder and Hand questionnaire score, assuming 20% loss to follow-up. Secondary outcomes will include function, pain, quality of life, complications, cost-effectiveness, time off work, and ability to drive. Discussion The results of this trial will provide evidence regarding clinical and cost-effectiveness between surgical and non-surgical treatment of humeral shaft fractures. Ethical approval has been obtained from East of England – Cambridge Central Research Ethics Committee. Publication is anticipated to occur in 2024. Cite this article: Bone Jt Open 2024;5(4):343–349.
目的 肱骨干骨折占所有骨折的3%至5%。在英国,孤立性肱骨干骨折最常见的治疗方法是使用功能性支具进行非手术治疗,并发症风险较低,但与手术相比,愈合时间更长,骨折不愈合的风险更高。现在越来越多的人倾向于手术治疗,因为与功能性支具相比,手术治疗可能会使功能恢复更快,骨折不愈合的发生率更低。然而,手术也存在固有风险,包括感染、出血和神经损伤。本试验旨在评估在治疗肱骨轴骨折时,功能性支撑与手术固定相比的临床和成本效益。方法 HUmeral SHaft(HUSH)骨折研究是一项多中心、前瞻性的随机优越性试验,对成年患者的肱骨干骨折进行手术与非手术干预的比较。参与者将被随机分配接受功能性支具或手术治疗。该试验有334名参与者,假设随访损失率为20%,则有90%的力量可以检测出手臂、肩部和手部残疾问卷评分的临床重要差异。次要结果将包括功能、疼痛、生活质量、并发症、成本效益、停工时间和驾驶能力。讨论 该试验的结果将为肱骨轴骨折手术治疗和非手术治疗的临床和成本效益提供证据。该试验已获得东英格兰-剑桥中央研究伦理委员会的伦理批准。预计将于2024年发表。引用本文:Bone Jt Open 2024;5(4):343-349.