Revisiting the debate on operative vs nonoperative management of humeral shaft fractures

Abstract

Operative management of humeral shaft fractures demonstrates superior early functional recovery (6-month Disabilities of the Arm, Shoulder, and Hand scores) and significantly lower nonunion rates (63.9% reduction) compared to functional bracing, particularly in complex cases, while conservative treatment remains viable for low-demand patients. Surgical techniques, including open reduction internal fixation, intramedullary nailing, and minimally invasive plate osteosynthesis, offer trade-offs between anatomic precision and complication risks (e.g., radial nerve injury vs rotator cuff damage), with over 90% of radial nerve injuries resolving spontaneously. Ultrasound-guided diagnosis (89% sensitivity, 95% specificity) optimizes decision-making for nerve entrapment. Individualized treatment selection, prioritizing fracture complexity and patient needs, is critical to balance accelerated rehabilitation with minimized complications.

Keywords: Operative; Nonoperative; Functional brace; Humeral shaft fractures; Disabilities of the Arm, Shoulder, and Hand

Core Tip: Historically, humeral shaft fractures were predominantly managed through conservative methods. However, with advancements of open reduction internal fixation and intramedullary nailing, the rate of surgical intervention has gradually increased. But according to the previous literature, there were not consistent conclusions about conservative and surgical treatments. While conservative treatment avoids surgical complications and functional bracing has outstanding results, both operative and nonoperative follow-up periods and the potential for complications like nonunion, malunion, and loss of reduction are still debated. Patients in the surgery group benefit from early functional activities, but there is a risk of infection, nonunion, and failure of the internal fixation. Compared with conservative treatment, the surgery group has similar Disabilities of the Arm, Shoulder, and Hand scores at 12 months. Hematopoiesis is further disrupted by disturbed intraoperative soft tissue, and nonunion can result from potential instability in conservative treatment approaches.