Operative versus non-operative treatment of humeral shaft fractures: A systematic review

Abstract

Background Humeral shaft fractures are common but debate still occurs as to whether these are best managed operatively or non-operatively. We sought to undertake a systematic review and meta-analysis of randomised and non-randomised studies to clarify the optimal treatment. Methods We performed a search for all randomised and non-randomised comparative studies on humeral shaft fracture. We included only those with an operative and non-operative cohort in adult patients. We undertook a meta-analysis of the following outcome measures: nonunion, malunion, delayed union, iatrogenic nerve injury and infection. Non-operative management was with a functional brace. Results Non-operative management resulted in a significantly higher nonunion rate of 17.6% compared to 6.3% with fixation. Operative management had a significantly higher iatrogenic nerve injury rate of 3.4% and infection rate of 3.7%. All nonunions within the included studies went on to union after plate fixation. There was no significant difference in delayed union or patient reported outcome measures. There was a significantly increased risk of malunion with non-operative treatment however this did not correlate with the outcome. Discussion Our findings suggest that in the majority of cases, humeral shaft fractures can be managed with non-operative treatment, and any subsequent nonunion should be treated with plate fixation.

Treatment of humeral shaft fractures: a new minimally-invasive plate osteosynthesis versus open reduction and internal fixation: a case control study

“…In the posterior approach group, a double LCP was placed medially and laterally on the humerus. Passive movement of the shoulder and elbow joints was then used to examine the stability of the bone plate structure, a drainage tube was placed under the muscle, then the incision was sutured [ 10 ].…”

Closed Fracture Treatment in Adults, When is it Still Relevant?

“…[28][29][30] The location of the fracture within the bone determines successful healing with union rates of up to 88% for middle and distal third shaft fractures and 76% for proximal third shaft fractures. 31 However, certain humeral fracture characteristics (e.g., spiral and oblique fracture patterns) should guide orthopedic surgeons towards ORIF. 32,33 FOREARM FRACTURES Isolated ulna fractures can generally be treated with immobilization as long as there is some overlap of the fracture ends with proper alignment.…”

The management of displaced humeral shaft fractures – A survey of UK shoulder and elbow surgeons

“…1,2 Closed HSFs have traditionally been treated non-operatively with immobilisation in either a plaster or a functional brace. [3][4][5] There has been a steady increase in the rate of surgery over last few decades for displaced fractures despite there being limited evidence to support superior outcomes over non-operative treatment. 4,5 Surgery is generally indicated for polytrauma, 6 segmental fractures, 7 open fractures or those with a vascular injury.…”

“…[3][4][5] There has been a steady increase in the rate of surgery over last few decades for displaced fractures despite there being limited evidence to support superior outcomes over non-operative treatment. 4,5 Surgery is generally indicated for polytrauma, 6 segmental fractures, 7 open fractures or those with a vascular injury. It may also be indicated for a progressive radial nerve palsy or when a trial of non-operative treatment has failed.…”

“…3–5 There has been a steady increase in the rate of surgery over last few decades for displaced fractures despite there being limited evidence to support superior outcomes over non-operative treatment. 4,5…”