Humeral shaft fracture: systematic review of non-operative and operative treatment

Saskia H Van Bergen; Kiran C Mahabier; Esther M M Van Lieshout; Tim Van der Torre; Cornelia A W Notenboom; Priscilla A Jawahier; Michael H J Verhofstad; Dennis Den Hartog

doi:10.1007/s00402-023-04836-8

Humeral shaft fracture: systematic review of non-operative and operative treatment

Arch Orthop Trauma Surg. 2023 Aug;143(8):5035-5054. doi: 10.1007/s00402-023-04836-8. Epub 2023 Apr 24.

Authors

Saskia H Van Bergen¹, Kiran C Mahabier¹, Esther M M Van Lieshout¹, Tim Van der Torre¹, Cornelia A W Notenboom¹, Priscilla A Jawahier¹, Michael H J Verhofstad¹, Dennis Den Hartog²

Affiliations

¹ Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
² Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. d.denhartog@erasmusmc.nl.

Abstract

Introduction: Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome.

Methods: Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc.

Results: A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84-92%), 94% (95% CI 92-95%) for the IMN group and 96% (95% CI 95-97%) for the plating group. The rate of secondary radial nerve palsies was 1% in patients treated non-operatively, 3% in the IMN, and 6% in the plating group. Intraoperative complications and implant failures occurred more frequently in the IMN group than in the plating group. The DASH score was the lowest (7/100; 95% CI 1-13) in the minimally invasive plate osteosynthesis group. The Constant-Murley and UCLA shoulder score were the highest [93/100 (95% CI 92-95) and 33/35 (95% CI 32-33), respectively] in the plating group.

Conclusion: This study suggests that even though all treatment modalities result in satisfactory outcomes, operative treatment is associated with the most favorable results. Disregarding secondary radial nerve palsy, specifically plate osteosynthesis seems to result in the highest fracture healing rates, least complications, and best functional outcomes compared with the other treatment modalities.

Keywords: Complication; Fracture healing; Humeral shaft fracture; Non-operative treatment; Operative treatment; Review.

Publication types

Systematic Review
Review

MeSH terms

Bone Plates / adverse effects
Fracture Fixation, Internal / methods
Fracture Fixation, Intramedullary* / adverse effects
Fracture Healing / physiology
Humans
Humeral Fractures* / complications
Humeral Fractures* / surgery
Humerus
Radial Neuropathy* / etiology
Treatment Outcome