ArticleCureus2025
Humeral Shaft Fractures: Retrospective Cohort Comparing Operative Versus Nonoperative Management.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
introductionOperative 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.
methodsWe 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.
resultsQuickDASH 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).
conclusionsAt 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.
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