Initial Displacement of Humeral Shaft Fractures is Associated with Failure of Nonoperative Management.

Abstract

To determine if the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management. Retrospective cohort study. Urban level 1 trauma centerPatients/Participants: 106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively. Functional bracing. Failure of nonoperative management, defined as conversion to surgery, malunion, delayed union/nonunion. Nonoperative management failed in 33 (31%) of 106 included patients with 27 (25%) patients requiring surgery. On multivariate analysis, female gender (odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21), American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior-posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11° (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, one, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively. Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cutoff values were established that may be used by surgeons to counsel patients with these injuries. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.