title: Management of Closed Diaphyseal Humerus Fractures in Patients With Injury Severity Score ≥17.
abstract: OBJECTIVE
  The management of closed diaphyseal humerus fractures in the polytrauma patient varies widely. The aim of this study was to compare outcomes of operative and nonoperative management in this patient population.
  
  
  METHODS
  Single-center, retrospective cohort analysis.
  
  
  METHODS
  Urban, Level 1 trauma center.
  
  
  METHODS
  Seventy-one patients with closed diaphyseal humerus fractures, and Injury Severity Score (ISS) of ≥17, treated between 2006 and 2011 were identified.
  
  
  METHODS
  Patients were treated operatively versus nonoperatively with a functional brace by surgeon preference.
  
  
  RESULTS
  Primary outcome was union. Secondary outcomes included time to union, time to release to weightbearing, and complications other than nonunion.
  
  
  RESULTS
  There was no statistical difference between age, Injury Severity Score, or fracture type between the 2 cohorts. There was a statistically higher incidence of associated orthopaedic injury, and more specifically, lower extremity injury in the group treated with operative intervention. There was no difference in union rates (95% operative, 94% nonoperative), time to union (17 weeks operative, 15 weeks nonoperative), or complication rates between the 2 groups. Time to release to weightbearing was 3 weeks shorter in the operative group (9.3 weeks operative, 12.8 weeks nonoperative).
  
  
  CONCLUSIONS
  Polytrauma patients with closed diaphyseal humerus fractures can be treated successfully with equivalent union rates, time to union, and complication rates when selected for conservative management techniques. The decision to undertake operative management of closed diaphyseal humerus fractures in the polytraumatized patient is multifaceted and should consider patient expectations, demographics, injury profile, and ambulatory status.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †Quincy Medical Group, Quincy, IL; and ‡University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Dielwart
authors.forename: Luke
authors.initials: L
authors.lastname: Harmer
authors.forename: Jeremy
authors.initials: J
authors.lastname: Thompson
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Seymour
authors.forename: Madhav A
authors.initials: MA
authors.lastname: Karunakar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001915:Braces / Q000706:statistics & numerical data*; D015331:Cohort Studies; D018483:Diaphyses / Q000293:injuries* / Q000601:surgery; D005260:Female; D005592:Fracture Fixation / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D007103:Immobilization / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology* / Q000628:therapy; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult