Session IV - Upper Extremity

Distal Third Diaphyseal Humerus Fractures: Operative versus Non-operative Treatment

David C. Ring, MD¹ (a-AO Foundation); Andrew Jawa, MD² (n);

L. Pearce McCarty, MD² (n); Mitchel B. Harris, MD² (n);

¹Massachusetts General Hospital, Boston, Massachusetts, USA;

²Brigham and Women's Hospital, Boston, Massachusetts, USA

Purpose: This study was conducted to compare the treatment of distal third diaphyseal humerus fractures with either functional bracing or plate and screw fixation.

Methods: 34 consecutive patients with closed extra-articular fractures of the distal third of the humeral diaphysis were identified from a prospective orthopaedic trauma database. 17 were treated with plate and screw fixation and 17 were treated with functional bracing. The cohorts were comparable; the primary difference was the preference of the treating surgeon. Pretreatment radial nerve palsy was present in five patients treated surgically and 2 of the patients treated with bracing.

Results: All of the injury-related radial nerve palsies recovered completely in both cohorts. Among operatively treated patients, one had early loosening of fixation and one had nonunion; both healed after repeat plate fixation and bone grafting. Two new postoperative radial nerve palsies developed and have not recovered; one patient was treated with tendon transfers. One new postoperative ulnar nerve palsy developed and resolved. All fractures ultimately healed in anatomic or near anatomic alignment with full or nearly full range of motion. Among patients treated nonoperatively, all 17 fractures healed and only one patient >30° of malalignment in any plane. One patient developed skin breakdown during treatment and completed treatment in a sling. Only one patient lost >10° of elbow or shoulder motion.

Conclusions: Extra-articular distal-third diaphyseal humerus fractures can be treated with either functional bracing or plate and screw fixation. Each technique has advantages and disadvantages. Operative treatment achieves more predictable alignment and potentially quicker return of function, but risks of iatrogenic nerve injury and reoperation. Functional bracing can be associated with skin problems and varying degrees of angular deformity, but healing, motion, and function are usually excellent.