Clinical outcomes of three treatment methods for humeral shaft fractures: a comparative study

Objective To compare the clinical efficacy of three techniques (nonoperation, external fixation, and open reduction and plate osteosynthesis) for the treatment of diaphyseal fractures of the humerus, thereby providing guidance for the selection of treatment methods. Methods A retrospective analysis was conducted on 138 patients with humeral shaft fractures who received treatment at the Department of Orthopedics and Traumatology, Hubei Provincial Hospital of Traditional Chinese Medicine between January 2021 and December 2024, all with complete follow-up data. The patients were divided into three groups based on their treatment methods: the nonoperative treatment (NOT) group, the external fixation (EF) group, and the open reduction and plate osteosynthesis (ORPO) group. In the NOT group, 46 patients received small splint fixation/plaster/functional bracing. There were 28 patients in the EF group and 64 patients in the ORPO group. The patients were followed up regularly at outpatient appointments or by telephone. The follow-up evaluations included measurements of fracture-healing time, fracture-healing rate, postoperative complications, length of hospital stay, and time to return to work after treatment. Furthermore, the clinical outcomes included the Constant shoulder score, the Mayo elbow score, and patient satisfaction at the last follow-up. Results The mean follow-up durations for the NOT, EF, and ORPO groups were 21.4 ± 3.7, 20.1 ± 4.7, and 22.6 ± 5.4 months, respectively. The mean union times for the NOT, EF, and ORPO groups were 9.0 (8.0–11.25) months, 10.0 (9.0–12.0) months, and 12.0 (10.25–12.0) months, respectively; additionally, the mean union rates were 95.7%, 96.4%, and 96.9%, respectively. There were significant differences in union time among the three groups ( P = 0.002, ε 2 = 0.079), but the magnitude of the difference was limited. The main complications were significantly different among the three groups ( P < 0.001, V = .438). Residual deformity/malunion was the main complication in the NOT group, while postoperative radial nerve palsy and infection were the main complications in the EF and ORPO groups, respectively. The length of hospital stay for the three groups was 4.0 (2.0–5.25) days, 10.5 (5.0–12.0) days, and 11.0 (8.0–15.0) days, respectively. The time to return to work after treatment for the three groups was 13.0 (10.0–16.0) weeks, 16.0 (14.25–18.75) weeks, and 14.0 (10.0–17.0) weeks, respectively. The mean duration of hospital stay and number of days away from work were significantly lower in the NOT group than in the other two groups ( P < 0.05 ), Although the hospitalization time in the EF group was shorter than that in the ORPO group, the time from treatment to return to work was longer, with both differences being statistically significant ( P < 0.05). At the last follow-up, the postoperative Constant scores and Mayo scores were not significantly different among the three groups ( P > 0.05 ). Patient satisfaction also differed significantly among groups, with higher satisfaction in the NOT group than in the EF and ORPO groups ( P < 0.05, η 2 = .046), although the effect size was small. Conclusions Within the limitations of this retrospective, non-randomized study, our findings suggest that all three treatment modalities achieve comparable fracture union rates and functional outcomes in humeral shaft fractures. Meanwhile, these results underscore the value of individualized treatment selection. In appropriately selected patients, NOT remains a viable and cost-effective option. But these findings should be validated in prospective trials.