Incidence and Functional

Outcomes of Malunion of
Nonoperatively Treated
Humeral Shaft
Fractures
Brandon M. Devers, MD; George F.
Lebus, MD; Hassan R. Mir, MD, MBA,
FACS

Journal Identity
American Journal Of Orthopedics
vol.44 issues 11, 29 Oktober 2015
hal 434-7

Background

> 200 angulation

Shortening > 2.5 cm

Rockwood CA, Green DP, Bucholz RW, eds. Rockwood and Greens Fractures in Adults. 7th ed.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010
Denard A Jr, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA. Outcome of
nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213

Methods
Sample were patients which 18 years old or
older with a humeral shaft fractured managed
nonoperatively beetween january 1,2001- June
30, 2012 with minimum 1-year follow up.
Variables:

Age at injury
Sex
Comorbidities
Return to work
Cosmetic
perception

Results
91 study eligible patients
15 met the radiographic criteria for
the diagnosis of malunion
Varus malunion 13 patients
Shortening 2 patients
Mean imobilization 10 weeks

 All patients were neurovasculary

intact at time of final clinical exam,
with return of full upper extremities
ROM.
Fracture management non-operative:
Coaptation splinting : 12 patients
Hanging arm cast : 1 patient
Posterior splint : 1 patient
Sling : 1 patient

 8 patients were reached for in-person

examination, and final follow up
6 of the 8 patients reported noticeable
cosmetic derfomity, most are varus (4
patients)
6 patients satisfied with the outcome of
their treatment.
2 patients dissatisfied with their
outcome because cosmetic appereance

 There was no apparent relationship

between outcome and degree of
residual deformity.

Discussion
Humeral shaft fractures usually
managed non-operatively. One of the
most disadvantages of non operative
management is residual angular
deformity.
Previous
study
have
reported
acceptable functional and cosmetic
outcomes with residual angular
0 bracing of humeral shaft fractures. A
Papasoulis E, Drosos GI, Ververidis AN, Verettas DA. Functional
deformity
less
than
20
.
review of clinical studies. Injury. 2010;41(7):e21-e27
Rutgers M, Ring D. Treatment of diaphyseal fractures of the humerus using a functional brace. J
Orthop Trauma. 2006;20(9):597-601

 The study found that malunion was

not
associated
with
functional
limitation
after
non-operative
management
of
humeral
shaft
fractures.
Most patients reported a noticeable
cosmetic deformity, and one-third of
these patients cited it as a major
reason for dissattisfaction with their
overall outcome.

Limitation
The major limitation of this study was
its small patient population.
The study was not designed to
evaluate the cause of malunion.

Conclusion
Malunion after nonoperative
management of humeral shaft
fractures does not appear to result in
significant disatisfaction, or
functional limitations.
The majority of patients reported a
noticeable cosmetic deformity
Operative intervention to prevent
malunion is not necessary.

Thank You
Michael Raja P. Sitorus