Management of Humeral Shaft Fractures; Non-Operative Versus Operative

Context: Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. There is an increasing trend in the literature to perform operative fixation of these fractures. Evidence Acquisition: The aim of this systematic review was to compare the level one evidence for the outcome of non-operative with operative management of humeral shaft fractures in adults. A comprehensive electronic literature search of Medline and PubMed was performed with specific inclusion criteria to identify randomized controlled trials. Results: In total, seventeen different studies were identified from the search terms and combinations used. Only one study met the inclusion criteria; however, this was a published study protocol of an ongoing trial currently being conducted. One additional published protocol for an ongoing trial was also identified, but this was for a prospective comparative observational study. Although this latter study may not be level one evidence, it would offer great insight into the functional outcome of humeral shaft fractures and economic implications of operative management, which is currently not addressed in the literature. Two retrospective comparative studies were also identified, one of which demonstrated a significantly lower rate of nonunion and malunion in those patients undergoing operative management. Conclusions: This systematic review demonstrated a deficiency in the current literature of level one evidence available for the management of humeral shaft fractures. The current ongoing randomized control trail would offer a greater insight into the management of humeral shaft fractures and help confirm or refute the current literature. If this randomized control trial affirms the reduction in the rate of nonunion with operative fixation, a cost economic analysis is essential. As it would seem to offer operative management to all patients may be over treatment and not to offer this at all would undertreat.