Civilian Ballistic vs Non-Ballistic Humeral Shaft Fractures: Comparing Rates of Union and Outcomes

Objectives Ballistic fractures have become increasingly prevalent in the United States. Outcomes after ballistic fractures are not well-studied. The purpose of this study was to compare rates of union, neurovascular injury, compartment syndrome, and infection between ballistic and non-ballistic humeral shaft fractures. Methods A retrospective review was performed at a single urban level I trauma center over 10 years for patients with extra-articular humeral shaft fractures. Patients were separated into two groups based on the mechanism of injury. Outcomes were collected and compared between the two groups. Results In total, we had 122 patients, including 32 with ballistic fractures and 91 with non-ballistic fractures. There was no significant difference in union rates between the two groups (87.5% ballistic vs. 86.8% non-ballistic, p=0.88). Fractures treated nonoperatively had an 80.6% union rate (85.7% ballistic vs. 79.3% non-ballistic, p=0.59), whereas operatively treated fractures had a 96.1% union rate (88.9% ballistic vs. 100% non-ballistic, p=0.06). Nerve injury was present in 13.0% of fractures (34.4% ballistic vs 5.5% of non-ballistic, p<0.01). There were eight vascular injuries, seven in the ballistic group and one in the non-ballistic group (21.9% vs. 1.1%, p<0.01). Infections occurred in five patients in the ballistic group and two patients in the non-ballistic group (15.6% vs. 2.2%, p<0.01). Conclusion Civilian ballistic humeral shaft fractures have similar rates of fracture union to non-ballistic humeral shaft fractures. Ballistic fractures had higher rates of neurovascular injury and infection compared to non-ballistic fractures. A higher infection rate may be due to open wounds from multiple surgeries.