Review Question - QID 217835

This patient has a closed midshaft humeral fracture within the acceptable parameters for nonoperative treatment. If the patient develops a varus malunion, they are usually well tolerated with no effect on functional outcomes.

The vast majority of humeral shaft fractures can be managed nonoperatively, especially if they fall within acceptable alignment parameters (sagittal plane <20 deg, coronal plane <30 deg, and <3 cm shortening). A risk of nonoperative treatment is varus malunion, particularly with transverse fracture patterns. However, varus malunion is generally well tolerated with little effect on clinical outcomes due to the mobility of the shoulder and elbow.

Devers et al performed a retrospective cohort study of 91 patients with a humeral shaft fracture treated nonoperatively to estimate the overall incidence of malunion and the long-term outcomes of patients with a malunion. They found that 15% had a malunion and that 75% of those with a malunion reported no functional limitations and were satisfied; 75% reported a cosmetic deformity of which 25% were dissatisfied. The authors concluded that for a majority of patients, malunion does not cause significant pain, functional limitations, or dissatisfaction.

Shields et al retrospectively reviewed 32 patients with a humeral shaft fracture treated nonoperatively to determine if residual angular deformity correlates with functional outcomes. At an average follow-up of 47 ± 29 months, sagittal plane deformity up to 18° and coronal plane deformity up to 27° had no correlation with patient-reported outcomes or patient satisfaction.

Incorrect Answers
Answer 1-3, 5: Residual deformity does not result in an increased risk of nonunion, result in prolonged pain, have a negative effect on functional outcomes or decrease the likelihood of resolution of nerve palsy.