Humeral shaft fractures: how effective really is functional bracing?

Background: The aim of this study was to assess the effectiveness of functional bracing in the treatment of humeral shaft fractures and identify factors that increased the risk of delayed or non-union. Methods: All patients with humeral shaft fractures treated at Musgrove Park Hospital between 2010 and 2017 were identified. Patient electronic records were reviewed to identify demographic data, as well as outcomes and complications following treatment. Radiographs were reviewed to identify fracture pattern and location as well as fracture displacement and angulation. Results: In total, 65 patients were treated with functional bracing of which 22 patients (34%) had a delayed or non-union. Fracture displacement and angulation were significantly associated with delayed or non-union. In particular, patients with fractures displaced more than 30 mm or angulated more than 30 degrees had a significantly higher risk of delayed or non-union. Fracture location or pattern was not significantly associated with delayed or non-union. Conclusion: Functional bracing is an effective treatment modality for the majority of patients with humeral shaft fractures, but patients with markedly displaced or angulated fractures are at a higher risk of failure of conservative treatment and therefore early operative intervention should be considered.