Surgery vs Functional Bracing for Closed, Displaced Humeral
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The JAMA study states that nonoperatively treated patients who experienced fracture healing problems that required secondary surgery had inferior outcomes at 2-year follow-up compared with patients whose fractures healed successfully, irrespective of whether the latter was initially treated with surgery or with functional bracing.

The aim of the study was to compare the 2-year outcomes of patients who required secondary surgery with the outcomes of patients with successful initial treatment.

This 2-year follow-up of the Finnish Shaft of the Humerus (FISH) randomized clinical trial comparing surgery with nonoperative treatment (functional brace) was completed in January 2020. A total of 321 adult patients with closed, displaced humeral shaft fractures were assessed for eligibility. After excluding patients with cognitive disabilities, multimorbidity, or multiple trauma and those refusing randomization, 82 patients were randomized.

Of 82 randomized patients, 38 were female. The mean age was 48.9 years. A total of 74 patients completed the 2-year follow-up.

--At 2 years, the mean DASH score was 6.8 in the initial surgery group, 6.0 in the bracing group, and 17.5 in the second surgery group.

--The between-group difference was ?10.7 points between the initial and secondary surgery groups and ?11.5 points between the bracing group and secondary surgery group.

In conclusion, patients contemplating treatment for closed humeral shaft fracture should be informed that two-thirds of patients treated with functional bracing may heal successfully while one-third may experience fracture healing problems that require secondary surgery and lead to inferior functional outcomes 2 years after the injury.