Modern Results of Functional Bracing of Humeral Shaft Fractures: A Multicenter Retrospective Analysis.
OBJECTIVES To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention. DESIGN Multicenter, retrospective analysis SETTING: Nine Level 1 trauma centers across the United States. PATIENTS 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 2015 were reviewed retrospectively from nine institutions. INTERVENTION functional brace MAIN OUTCOME MEASUREMENTS: Conversion to surgery RESULTS: A total of 344 fractures (29% ultimately underwent surgical intervention. Reasons for conversion included: nonunion (60% malalignment beyond acceptable parameters (24% inability to tolerate functional bracing (12% and persistent signs of radial nerve palsy requiring exploration (3.7% Univariate comparisons showed that females and Caucasians were significantly (p <0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P <0.05) Proximal shaft as well as comminuted, segmental and butterfly fractures were also linked to a higher rate of conversion. CONCLUSIONS This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures.
Journal of orthopaedic trauma