Humeral Shaft Fractures: Retrospective Cohort Comparing Operative Versus Nonoperative Management

Operative fixation and functional bracing are established options for humeral shaft fractures, yet comparative patient-reported outcomes at one year remain debated. We compared 12-month function and pain between treatments.

We included 74 patients (36 treated surgically with plate fixation and 38 with functional bracing). Retrospective analysis of a prospective cohort (Hospital de Caridade São Vicente de Paulo, a tertiary center in Jundiaí, São Paulo, Brazil, January 2020-December 2021), including adults with AO 12 A2/A3/B2 diaphyseal fractures treated with plate osteosynthesis or functional bracing. Primary outcomes were QuickDASH and Visual Analog Scale (VAS) pain at baseline and 12 months. ANCOVA adjusted for baseline and age; a sensitivity model included complications.

QuickDASH improved from 72.4±9.5 to 23.2±19.7 (Δ-49.2±18.3) with bracing and from 76.0±9.4 to 28.6±25.5 (Δ-47.4±21.9) with surgery, with between-group Δ p = 0.701. VAS fell from 6.4±1.2 to 1.8±2.1 and from 6.6±1.5 to 2.4±2.8, with between-group Δ p = 0.497. Adjusted 12-month differences (surgery-conservative) were QuickDASH +3.76 (95% CI -5.91 to +13.43; p = 0.446) and VAS +0.65 (-0.35 to +1.66; p = 0.202). Complications occurred in 19/74 (25.6%; 12 surgical, seven conservative): radial nerve neurapraxia 12/74 (all resolved ≤6 months), delayed union in three surgical (grafted at four months), and nonunion in four conservative (converted to surgery). In adjusted models, any complication independently worsened 12-month QuickDASH (+23.15; 95% CI +2.78 to +43.53; p = 0.026) but not VAS (+0.02; p = 0.979).

At 12 months, surgical fixation and functional bracing yield comparable patient-reported function and pain. Treatment should be individualized, while prevention and prompt management of complications may have a greater impact on functional recovery than the initial modality.