title: Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial.
abstract: BACKGROUND
  Nonoperative treatment has historically been considered the standard for fractures of the shaft of the humerus. Minimally invasive bridge-plate osteosynthesis for isolated humeral shaft fractures has been proven to be a safe technique, with good and reproducible results. This study was designed to compare clinical and radiographic outcomes between patients who had been treated with bridge plate osteosynthesis and those who had been managed nonoperatively with a functional brace.
  
  
  METHODS
  A prospective randomized trial was designed and included 110 patients allocated to 1 of 2 groups: surgery with a bridge plate or nonoperative treatment with a functional brace. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. The score on the Short Form-36 (SF-36) life-quality questionnaire, complications of treatment, Constant-Murley score for the shoulder, pain level, and radiographic results were assessed as secondary outcomes. Participants were assessed at 2 weeks; 1, 2, and 6 months; and 1 year after the interventions.
  
  
  RESULTS
  The mean DASH score of the bridge plate group was statistically superior to that of the functional brace group (mean scores, 10.9 and 16.9, respectively; p = 0.046) only at 6 months. The bridge plate group also had a significantly more favorable nonunion rate (0% versus 15%) and less mean residual angular displacement seen on the anteroposterior radiograph (2.0° versus 10.5°) (both p < 0.05). No difference between the groups was detected with regard to the SF-36 score, pain level, Constant-Murley score, or angular displacement seen on the lateral radiograph.
  
  
  CONCLUSIONS
  This trial demonstrates that, compared with functional bracing, surgical treatment with a bridge plate has a statistically significant advantage, of uncertain clinical benefit, with respect to self-reported outcome (DASH score) at 6 months, nonunion rate, and residual deformity in the coronal plane as seen on radiographs.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Division of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Universidade Federal de São Paulo-Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
authors.forename: Fabio Teruo
authors.initials: FT
authors.lastname: Matsunaga
authors.forename: Marcel Jun Sugawara
authors.initials: MJ
authors.lastname: Tamaoki
authors.forename: Marcelo Hide
authors.initials: MH
authors.lastname: Matsumoto
authors.forename: Nicola Archetti
authors.initials: NA
authors.lastname: Netto
authors.forename: Flavio
authors.initials: F
authors.lastname: Faloppa
authors.forename: Joao Carlos
authors.initials: JC
authors.lastname: Belloti
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001915:Braces; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation*; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D006810:Humeral Fractures / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D059352:Musculoskeletal Pain / Q000209:etiology; D011446:Prospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult