Treatment of Midshaft Humerus Fractures Using Early Functional Bracing: Results and Prognostic Factors.

Purpose Our study tests the hypothesis that a new radiographic measurement, the fracture displacement index (FDI), is associated with the prediction of successful conservative treatment, and investigates factors, that contribute to failure treatment. Methods This was a retrospective case series reporting the results of pragmatic treatment of midshaft humerus fractures using a humeral brace. Details regarding the patient demographics and fracture pattern were recorded. The outcome was measured as patient satisfaction, return to activities, and need for further treatment at a minimum of one year from the discharge date. Results Of the 33 surviving patients, who met the inclusion criteria, two subgroups were developed. The conservatively treated brace group (n=23, 70%) and the surgical group (n=10, 30%). The median age of brace group patients was 48.3 years, significantly less (p=0.0025) than the surgical (72 years). There were no significant differences in the rest of both group demographics. On the first available x-ray after the brace application, there was a significant difference in FDI (p=0.001) between groups. Residual angulation was significantly better for the surgical group. Skin breakdown was the most common complication, followed by forearm swelling. Stiffness was common in both groups.  Conclusion Patients with FDI near 50 younger than 60 years have better chances to proceed to union if treated with brace less than 24 hours after the injury. Patients with FDI larger than 100, older than 78, have a higher risk of requiring surgery. All patients should be counseled about the risk for skin complications and developing forearm swelling.