Care for Humeral Shaft Fractures — Pick Your Poison
Even the best evidence is underwhelming, making it a clinical decision for the surgeon and patient
What’s the Claim?
This better-than-average meta-analysis did a nice job painting a picture of the trade-offs between surgery and nonsurgical care among patients with diaphyseal humeral shaft fractures. Patients treated with surgery had far fewer nonunions (<1% compared with 16%), far more radial nerve palsies (17% versus < 1%), and “better” outcomes scores at 6 months (with no differences at a year) — but note the scare quotes around that last claim.
How’s It Stack Up?
As a meta-analysis, it stacks up well with the source material that it included, which, in this case, was randomized trials. Everyone knows this is a hot topic, and that there have been a gazillion studies on it, but this meta-analysis found only four that were eligible. Still, we see this as a feature, not a bug; most of what is available are case series with inconsistent (and inconsistently applied) inclusion criteria and substantial loss to follow-up. By limiting inclusion here to the cream of the crop, readers can be confident that they’re making their decisions (and counseling their patients) based on what truly is, in this case, the best-available evidence.
