Outcome after closed functional treatment of humeral shaft fractures

Objective: The aim of this study was to investigate the outcome after an isolated humeral shaft fracture treated primarily non-operatively with a fracture brace. Setting: University hospital. Design: Descriptive study. Retrospective assessment of clinical and radiographic healing. Prospective assessment of functional outcome and health-related quality of life (HRQoL). Patients: Seventy-eight patients (female, n = 45), mean age 58 (range, 16-91) years with isolated humeral shaft fractures. Intervention: Closed functional treatment with a fracture brace Main Outcome Measurements: Fracture healing, need for revision surgery. Short Musculoskeletal Functional Assessment (SMFA), HRQoL according to the Short Form 36 (SF-36) and patient-reported recovery. Results: Ninety percent of the fractures healed after nonoperative treatment, and nearly 90% of the nonunions healed after revision surgery. There was a trend toward more frequent nonunions in simple fractures, that is, type A according to the Orthopedic Trauma Association (OTA) classification (P = 0.08). The nonunion rate in type A fractures located in the proximal and middle part of the shaft was approximately 20%. Nearly 50% of the patients reported full recovery after successful nonoperative treatment, but none of the patients with a healed nonunion did after revision surgery (P < 0.05). The SMFA scores for arm/hand function were acceptable for the patients who healed after the primary fracture-brace treatment, but the values were worse for those with a healed nonunion after revision surgery. The SF-36 scores were generally slightly lower compared with a Swedish reference population. Conclusion: This study confirms the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture-brace treatment. However, in simple (type A) fractures. the nonunion rate seems to be higher, and patients with healed nonunions after revision surgery reported worse functional outcomes. Based on these findings, it seems reasonable to explore the use of plate fixation compared with nonoperative treatment for selected fracture types in a randomized controlled trial.