Revisiting the debate on operative vs nonoperative management of humeral shaft fractures.

Abstract

Operative management of humeral shaft fractures demonstrates superior early functional recovery (6-month Disabilities of the Arm, Shoulder, and Hand scores) and significantly lower nonunion rates (63.9% reduction) compared to functional bracing, particularly in complex cases, while conservative treatment remains viable for low-demand patients. Surgical techniques, including open reduction internal fixation, intramedullary nailing, and minimally invasive plate osteosynthesis, offer trade-offs between anatomic precision and complication risks (e.g., radial nerve injury vs rotator cuff damage), with over 90% of radial nerve injuries resolving spontaneously. Ultrasound-guided diagnosis (89% sensitivity, 95% specificity) optimizes decision-making for nerve entrapment. Individualized treatment selection, prioritizing fracture complexity and patient needs, is critical to balance accelerated rehabilitation with minimized complications.