Review Question - QID 4574

Closed treatment of humeral shaft fractures with functional bracing is indicated in the vast majority of isolated injuries. An ipsilateral brachial plexus injury, however, is a contraindication to nonoperative management in a functional brace.

Indications for operative management of humeral shaft fractures are limited given the high rates of union and ability of adjacent joints to compensate for deformity. Intact muscular tone is necessary to effect bony apposition in closed treatment with a functional brace. The absence of neurologic and muscle function in patients with a flail extremity leads to increased rates of nonunion and malunion.

Rutgers and Ring conducted a retrospective review of patients managed with functional bracing of humeral shaft fractures at a single institution. The authors found a 90% overall union rate, with maintenance of shoulder and elbow motion. They caution though, that 29% of their proximal third fractures went on to nonunion.

Figure A demonstrates an AP radiograph of a comminuted humeral shaft fracture with varus alignment.

Incorrect Answers:
Answer 1: Radial nerve injury is not an indication for operative management as the vast majority of radial nerve injuries recover with conservative management
Answer 2: 1cm of shortening is an acceptable deformity with closed management
Answer 3: 20 degree varus deformity is not an indication for operative management
Answer 5: Fracture comminution is not a contraindication to functional bracing