Initial Displacement of Humeral Shaft Fractures Is Associated With Failure of Nonoperative Management.

OBJECTIVES

To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management.

DESIGN

Retrospective cohort study.

SETTING

Urban level 1 trauma center.

PATIENTS/PARTICIPANTS: 106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively.

INTERVENTION

Functional bracing.

MAIN OUTCOME MEASUREMENTS

Failure of nonoperative management, defined as conversion to surgery, malunion, and delayed union/nonunion.

RESULTS

Nonoperative management failed in 33 (31%) of 106 included patients with 27 patients (25%) requiring surgery. On multivariate analysis, female sex [odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21], American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior-posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11 degrees (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, 1, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively.

CONCLUSIONS

Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cut-off values were established that may be used by surgeons to counsel patients with these injuries.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.