Humeral Shaft Fractures: Surgical versus Nonsurgical Management in Workers' Compensation

The optimal surgical indications for humeral shaft fractures in the working population remain uncertain. This study investigates the impact of surgical fixation on return to duty, union, and complications in workers' compensation patients with humeral shaft fractures.

All workers' compensation patients with humeral shaft fractures managed at a single institution between 2007 and 2017 were identified. Manual chart and radiographic review was performed to identify etiology of injury, type of work, time until return to duty, length of physical therapy, complications, and time to fracture union.

There were 39 humeral shaft fractures in workers' compensation patients managed at our institution (25 surgical; 64.1%). There was no difference in the return to light (106.1 versus 60.4 days; P=0.20) or full (140.1 vs. 139.9 days; P=0.99) duty for surgical versus nonsurgical treatment, respectively. There was no difference in the length of physical therapy (132.6 versus 106.3 days; P=0.15) or time to maximum medical improvement (174.3 vs. 198.8 days; P=0.25) for surgical versus nonsurgical treatment, respectively. Three patients returned to the operating room in the surgical group. Nonunion was observed in two surgical cases (8.0%) and one case (7.1%) of nonsurgical management.

This study did not identify an advantage for faster return to work after surgical management of humeral shaft fractures in workers' compensation patients. Though one of the perceived advantages of surgical fixation is a quicker return to physical activity, there may be other variables in this patient population that influence the timing of return to work.