Operative vs Nonoperative Management of Fractures of the Humeral Diaphysis: The Humeral Shaft Fracture Fixation Randomized Clinical Trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(20):64 JAMA Surg . 2025 May 1;160(5):508-516.What this means for my practice?
Fixation yields faster early recovery (function, mental HRQoL, pain/ROM) and a higher likelihood of returning to sport, but by 12 months patient-reported outcomes are equivalent to bracing; brace dermatitis is more common, and nonunion trends higher with bracing. Clinically, consider offering fixation to low-risk patients prioritizing earlier recovery, while discussing operative risks and the lack of 1-year differences. Limitations include single-center, pragmatic design with unblinded participants/assessors, modest sample size with crossover, and surgeon-discretion technique—factors that may affect generalizability.
Study Summary
Seventy patients with isolated, closed humeral shaft fractures (HSF) were randomized to operative fixation (n=36) or functional bracing (n=34). The primary outcome was the DASH score at 3 months. Secondary outcomes included EQ-5D/EQ-VAS, SF-12 PCS/MCS, pain, shoulder/elbow ROM, complications, radiographic alignment, and return to work/sport. Outcomes were assessed at 2 and 6 weeks and at 3, 6, and 12 months. Overall, the results revealed better DASH scores with surgery at 6 weeks and 3 months (p=.01 for both), but no differences at 6 or 12 months; surgery also improved early HRQoL and SF-12 MCS to 6 months, with higher return-to-sport rates. Brace-related dermatitis was more common with nonoperative care, and nonunion was numerically higher with bracing. These findings suggest early—but not sustained—advantages of fixation that must be weighed against operative risks.
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