A retrospective analysis of functional and radiographic outcomes of humeral shaft fractures treated operatively versus nonoperatively.

BACKGROUND

To determine differences in functional outcomes, return to work, and complications, in operatively vs. nonoperatively treated diaphyseal humeral shaft fractures.

METHODS

150 patients who presented to our center with a diaphyseal humeral shaft fracture (Orthopedic Trauma Association type 12) treated by open reduction internal fixation or closed reduction with bracing were retrospectively reviewed. Data collected included patient demographics, injury information, surgical details, and employment data. Clinical, radiographic, and patient-reported functional outcomes were recorded at routine standard-of-care follow-ups. Complications were recorded. Outcomes were analyzed using standard statistical methods and compared.

RESULTS

150 patients with a mean 24.4 months of follow-up (12 to 60 months) were included for analysis. 83 (55.3%) patients were treated with nonoperative care in a functional brace. The rest were treated surgically. The mean time to healing did not differ between the cohorts ( > .05). Patients treated operatively recovered faster with regards to functional elbow range of motion by 6 weeks ( = .039), were more likely to be back at work by 8 weeks after injury ( = .001), and demonstrated earlier mean time to return-to-daily activities ( = .005). Incidence of nonunion was higher in the nonoperative cohort (10.84% vs. 0%,  = .031). Three (4.5%) patients in the operative group developed iatrogenic, postoperative nerve palsy. Two patients in the operative group (4%) had a superficial surgical site infection.

CONCLUSION

More patients treated surgically had functional range of motion by 6 weeks. Functional gains should be weighed by the patient and surgeon against risk of surgery, nonunion, nerve injury, and infection when considering various treatment options to better accommodate patients' needs.