Skip to main content

Advertisement

SpringerLink
Log in

Humeral shaft fractures: results of operative and non-operative treatment

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

There has been little direct comparison between non-operative and operative management of humeral shaft fractures. The present study aimed to compare union rates and complication rates between these two modalities of treatment.

Methods

A retrospective cohort study was performed at a regional level 1 trauma centre. A total of 296 patients with humeral shaft fractures met inclusion criteria; 69 patients were treated with a functional brace and 227 with surgical intervention. The primary end point was radiographic union. Nonunion was defined as failure of radiological union at six months, requiring surgical intervention. Time to union, nerve palsy rate, and rate of infection were also examined.

Results

The nonunion rate was significantly higher in the non-operative group (23.2 % vs 10.2 %) despite higher rates of open fractures and high energy mechanisms of injury in the operative group. No significant difference in time to union was found. Nerve palsy was more common in the operative group (20 % vs 39 %); however, only two cases (1 %) of radial nerve palsy in the operative group were iatrogenic and both were transient. Infection rates were higher for the operative group (3.5 % vs 0 %).

Conclusions

Conservative treatment of humeral shaft fractures has a higher rate of nonunion, while operative treatment is associated with a low incidence of iatrogenic nerve palsy but higher rates of infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Balfour GW, Mooney V, Ashby ME (1982) Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg Am 64:11–13

    Article  CAS  PubMed  Google Scholar 

  2. Bercik MJ, Tjoumakaris FP, Pepe M, Tucker B, Axelrad A, Ong A, Austin L (2013) Humerus fractures at a regional trauma center: an epidemiologic study. Orthopedics 36(7):e891–e897. doi:10.3928/01477447-20130624-19

    Article  PubMed  Google Scholar 

  3. Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH (2006) Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis. Acta Orthop 77:279–284

    Article  PubMed  Google Scholar 

  4. Chapman JR, Henley MB, Agel J, Benca PJ (2000) Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 14:162–166

    Article  CAS  PubMed  Google Scholar 

  5. Chen X, Liu T (2016) Does emergency surgical treatment allow good nerve recovery in humeral diaphyseal fractures associated with radial palsy? Int Orthop 40(4):857–859. doi:10.1007/s00264-015-3037-7

    Article  PubMed  Google Scholar 

  6. DeFranco MJ, Lawton JN (2006) Radial nerve injuries associated with humeral fractures. J Hand Surg [Am] 31:655–663

    Article  Google Scholar 

  7. Denard A Jr., Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA (2010) Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics 33(8). doi: 10.3928/01477447-20100625-16.

  8. Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S (2006) Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg (Br) 88:1469–1473

    Article  CAS  Google Scholar 

  9. Ekholm R, Tidermark J, Tornkvist H, Adami J, Ponzer S (2006) Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma 20:591–596

    Article  PubMed  Google Scholar 

  10. Jensen AT, Rasmussen S (1995) Being overweight and multiple fractures are indications for operative treatment of humeral shaft fractures. Injury 26:263–264

    Article  CAS  PubMed  Google Scholar 

  11. Koch PP, Gross DF, Gerber C (2002) The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elb Surg 11:143–150

    Article  Google Scholar 

  12. Lavini F, Renzi Brivio L, Pizzoli A, Giotakis N, Bartolozzi P (2001) Treatment of non-union of the humerus using the Orthofix external fixator. Injury 32(Suppl 4):SD35–SD40

    Article  PubMed  Google Scholar 

  13. Li Y, Ning G, Wu Q, Feng S (2013) Review of literature of radial nerve injuries associated with humeral fractures-an integrated management strategy. PLoS One 8(11):e78576. doi:10.1371/journal.pone.0078576, eCollection 2013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Mahabier KC, Vogels LM, Punt BJ, Roukema GR, Patka P, Van Lieshout EM (2013) Humeral shaft fractures: retrospective results of non-operative and operative treatment of 186 patients. Injury 44(4):427–430. doi:10.1016/j.injury.2012.08.003

    Article  PubMed  Google Scholar 

  15. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133

    Article  CAS  PubMed  Google Scholar 

  16. Pailhé R, Mesquida V, Rubens-Duval B, Saragaglia D (2015) Plate osteosynthesis of humeral diaphyseal fractures associated with radial palsy: twenty cases. Int Orthop 39(8):1653–1657. doi:10.1007/s00264-015-2745-3

    Article  PubMed  Google Scholar 

  17. Papasoulis E, Drosos GI, Ververidis AN, Verettas DA (2010) Functional bracing of humeral shaft fractures. A review of clinical studies. Injury 41(7):e21–e27. doi:10.1016/j.injury.2009.05.004

    Article  PubMed  Google Scholar 

  18. Ring D, Chin K, Taghinia AH, Jupiter JB (2007) Nonunion after functional brace treatment of diaphyseal humerus fractures. J Trauma 62:1157–1158

    Article  PubMed  Google Scholar 

  19. Rose SH, Melton LJ 3rd, Morrey BF, Ilstrup DM, Riggs BL (1982) Epidemiologic features of humeral fractures. Clin Orthop Relat Res 168:24–30

    Google Scholar 

  20. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG (1977) Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am 59:596–601

    Article  CAS  PubMed  Google Scholar 

  21. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82:478–486

    Article  CAS  PubMed  Google Scholar 

  22. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg (Br) 87:1647–1652

    Article  CAS  Google Scholar 

  23. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE, Jarvinen MJ (2005) Functional treatment of closed humeral shaft fractures. Int Orthop 29:10–13

    Article  CAS  PubMed  Google Scholar 

  24. Tytherleigh-Strong G, Walls N, McQueen MM (1998) The epidemiology of humeral shaft fractures. J Bone Joint Surg (Br) 80:249–253

    Article  CAS  Google Scholar 

  25. Vaidya R, Sethi A, Oliphant BW, Gibson V, Sethi S, Meehan R (2014) Civilian gunshot injuries of the humerus. Orthopedics 37(3):e307–e312. doi:10.3928/01477447-20140225-66

    Article  PubMed  Google Scholar 

  26. van Middendorp JJ, Kazacsay F, Lichtenhahn P, Renner N, Babst R, Melcher G (2011) Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients. Eur J Trauma Emerg Surg 37(3):287–296. doi:10.1007/s00068-011-0099-0

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic and Rehabilitation Institute, 1307 Federal Street, 2nd Floor, Pittsburgh, PA, 15212, USA

    Edward Westrick

  2. Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH, 44106, USA

    Benjamin Hamilton

  3. Department of Orthopedics, University of California San Francisco, 500 Parnassus MU320W, San Francisco, CA, 94143, USA

    Paul Toogood

  4. Department of Orthopedics and Sports Medicine, Harborview Medical Center, 325 9th Ave., Seattle, WA, 98104, USA

    Bradford Henley & Reza Firoozabadi

Authors
  1. Edward Westrick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Toogood
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bradford Henley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reza Firoozabadi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Toogood.

Ethics declarations

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical review committee

This study was reviewed and approved by the institutional review board of Haborview Medical Center where this study was performed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Westrick, E., Hamilton, B., Toogood, P. et al. Humeral shaft fractures: results of operative and non-operative treatment. International Orthopaedics (SICOT) 41, 385–395 (2017). https://doi.org/10.1007/s00264-016-3210-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3210-7

Keywords

Search

Navigation