Background: There are strong advocates for both operative and
nonoperative treatment of distal-third diaphyseal fractures of the humerus,
but there are few comparative data. We performed a retrospective comparison of
these two treatment methods.
Methods: Fifty-one consecutive patients with a closed,
extra-articular fracture of the distal one-third of the humeral diaphysis were
identified from an orthopaedic trauma database. Forty patients were followed
for at least six months or until healing of the fracture. Eleven patients were
excluded because of inadequate follow-up. Nineteen patients had been managed
with plate-and-screw fixation, and twenty-one had been managed with functional
Results: Among the operatively treated patients, one had loss of
fixation, one had a postoperative infection, and one required tendon transfers
for the treatment of a preoperative radial nerve palsy that did not resolve.
Three new postoperative radial nerve palsies developed, and one had not
resolved when the patient was last evaluated, three months after surgery. All
operatively treated fractures healed with <10° of angular deformity,
and one patient lost 20° of shoulder or elbow motion. Among the
nonoperatively treated fractures, two were converted to plate fixation because
of the treating surgeons' concern regarding alignment and radial nerve palsy.
Only one patient had >30° of malalignment in any plane. Two patients
had development of skin breakdown during treatment and completed treatment in
a sling. Two patients lost =20° of elbow or shoulder motion.
Conclusions: For extra-articular distal-third diaphyseal humeral
fractures, operative treatment achieves more predictable alignment and
potentially quicker return of function but risks iatrogenic nerve injury and
infection and the need for reoperation. Functional bracing can be associated
with skin problems and varying degrees of angular deformity, but function and
range of motion are usually excellent.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.