Does motion at 8 weeks predict nonunion in nonoperatively managed humeral shaft fractures: A prospective multicenter evaluation

Abstract

Management with a functional brace results in successful union in the majority of patients with a humeral shaft fracture. An important factor in a patient's decision for operative vs. nonoperative management is how long it will take to know if the fracture will unite if treated nonoperatively. In this prospective multicenter evaluation subset analysis, we sought to address the following: (1) What is the positive and negative predictive value of gross motion at the fracture site on physical exam at 8 weeks post-injury for union in patients with humeral shaft fractures treated nonoperatively? (2) does callus present on radiographs correlate with clinical exam findings in terms of gross motion?

Methods

We performed a prospective multicenter observational trial to evaluate the PPV and NPV of gross motion at 8 weeks on the outcome of union. There was a proscription against surgery for a minimum of 12 weeks. We additionally evaluated the presence of callus on each cortex for those with gross motion.

Results

Of those available from the enrolled 101 patients, 62 (77 %) had no gross motion at 8 weeks following injury and went on to union (PPV=100 %). and 18 (23 %) patients had gross motion at the fracture site and 9 went on to nonunion (NPV =56 %), Callus was present on 3 of 4 cortices in 6 of the 7 patients with gross motion who went on to union and only 3 of the 9 who went on to nonunion (p = 0.06).

Conclusions

The lack of gross motion at the fracture site in patients treated nonoperatively for a humeral shaft fracture is highly predictive of union. The presence of gross motion does not predict nonunion as well, especially if callus is present on at least 3 of the 4 cortices. This information can be used to counsel patients at the inception of treatment and at 8 weeks.

Level of Evidence

II