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Treatment of Diaphyseal Fractures of the Humerus Using a Functional Brace

Objective: To determine humeral diaphyseal fractures at risk for nonunion with functional brace treatment. Design: Retrospective case series. Setting: A single surgeon's practice. Patients: Forty-nine of 52 consecutive patients treated nonoperatively for an isolated diaphyseal fracture of the humerus during a 6-year period were followed until either union and full or near-full restoration of shoulder and elbow motion, or until 6 months had passed, or until a reconstructive surgery was performed (average follow-up 14 months; range 2 to 50 months). Intervention: Functional fracture brace. Main Outcome Measurements: Radiographic and clinical union. Results: Union was achieved in 44 of 49 patients (90%) with no more than 15-degree loss of shoulder or elbow motion in any patient. Four of 14 proximal-third fractures (29%), one of 22 middle-third fractures (4%), and none of the 13 distal-third fractures failed to heal. Conclusions: Proximal-third long oblique fractures may be at greater than average risk for nonunion after functional fracture bracing. Level of evidence: Level IV (case series).