Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures?

Acknowledgements: Sarah Dawson, RN; Molly Moore; Martha B. Holden; Valda Frizzell; Lolita Ramsey; Andres Rodriguez; Janet Wells; John Garfi ; Chad Helgeson; and Holly Tyler-Paris Pilson. This study represents a collaboration of the Southeast Fracture Consortium (SEFS) and the Orthopaedic Trauma Research Consortium (OTRC). Our purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of 15° (AUC: 0.580) at 1-year follow-up. We found increased or worse disabilities of the arm, shoulder and hand (DASH) scores with > 10° sagittal alignment or > 15° of coronal alignment. Poor DASH scores were observed at angles lower than previously accepted for nonoperative treatment. These findings are useful in decision making and patient guidance. (Journal of Surgical Orthopaedic Advances 30(2):073–077, 2021)

Key Words: humeral shaft fractures, malunion, functional brace, nonunion, DASH score