Humeral Fractures Sustained During Arm Wrestling: A Retrospective Cohort Analysis and Review of the Literature.

Arm wrestling places significant torque on the humeral shaft. A spiral distal humeral shaft fracture is an unusual but significant injury that can result. Of 93 patients who presented between 2009 and 2017 with closed humeral shaft fractures that were managed nonoperatively, 9 sustained the fractures while arm wrestling. Outcomes were compared with those of all other patients with nonoperatively managed humeral shaft fractures sustained through other mechanisms. The Student's t test was used to compare cohorts. All patients had spiral fractures that occurred in the distal one-third of the humerus. All patients went on to achieve radiographic union after a mean of 13.6 weeks (95% confidence interval [CI], 11.5-15.6). At fracture healing, mean angulation of the humerus seen on the anteroposterior and lateral views was 15.1° (95% CI, 12.0°-18.2°) and 8.9° (95% CI, 3.7°-14.1°), respectively. Mean elbow flexion-extension arc was 141.1° (95% CI, 134.4°-147.8°), with mean forward shoulder elevation of 168.8° (95% CI, 153.3°-184.2°). On comparison of the patients with humeral shaft fractures sustained through arm wrestling with the patients with humeral shaft fractures sustained through other mechanisms, except for earlier time to healing for the former (P=.05), no significant differences were observed. This represents the first analysis of radiographic and clinical outcomes following these types of fractures. Those who sustain these fractures secondary to the high-torque moment of arm wrestling are not different from those who sustain these fractures secondary to other mechanisms, except for an earlier time to union. This study indicates that nonoperative management of all humeral shaft fractures results in radiographic union with favorable clinical outcomes. [Orthopedics. 2018; 41(2):e207-e210.].