Functional outcome of operative versus nonoperative treatment of humeral shaft fractures: results of a prospective multicenter cohort study

Objectives: The best treatment of humeral shaft fractures in adults is still under debate. This study aimed to compare functional and clinical outcome of operative versus nonoperative treatment in adult patients with a closed humeral shaft fracture.

Methods: From October 23, 2012 to October 3, 2018, 391 adult patients with a humeral shaft fracture AO type 12A or 12B were enrolled in a prospective cohort study in 29 hospitals. Patients either received operative (n=245) or nonoperative treatment (n=146). Outcome measures were the Disabilities of the Arm, Shoulder, and Hand (DASH; primary outcome), Constant-Murley score, pain (Visual Analog Score, VAS), quality of life (Short Form-36 (SF-36) and EuroQoL-5D-3L (EQ-5D)), range of motion of the shoulder and elbow, radiologic healing, complications, health care consumption, and cost-utility. Patients were followed for one year. Subgroup analysis was performed for the different AO subtypes.

Results and Conclusion: Patients in the operative group were younger (median 53 versus 62 years; p<0.001) and more often male (46% versus 35%; p=0.044). Other patient and injury characteristics were unrelated to treatment. Fracture classification differed between the groups (p=0.001), with AO 12 A3 fractures being more prominent in the operative group and 12 A1 and B1 more prominent in the nonoperative group. Overall, the median DASH score improved from 48.3 at two weeks to 17.5 at three months in the operative group, and from 59.2 to 25.9 in the nonoperative group (P<0.001). At 12 months, the DASH score was 3.3 in both groups. Earlier improvement in DASH score after operative treatment was also seen for the separate AO subtypes. The Constant-Murley scores as well as abduction, flexion, and external rotation of the shoulder were significantly better in the operative group until six months follow-up (P<0.01 for all fracture (sub)types). SF-36 Physical Component Summary and EQ-5D utility score were also superior in the operative group until three months (P<0.005 for all fracture (sub)types). SF-36 Mental Component Summary and EQ-5D VAS were superior for the operative group in the entire cohort, but this could not be demonstrated for the fracture subtypes. Although pain levels were slightly lower for the operative group in the first weeks, a significant effect of treatment on pain was not found.

Conclusions: The results of this large prospective multicenter cohort study show that operative treatment of a humeral shaft fracture results in earlier recovery of function, including range of motion and ability to perform specific tasks. However, at 12 months this effect was no longer statistically significant.

Stichwörter: Humeral shaft; Fracture; Outcome; Cohort study; Operative; Nonoperative; Treatment

Publication History

Article published online:
15 October 2020