Early Operative Management of Ballistic Humeral Shaft Fractures Is Associated With Shorter and More Predictable Course of Healing.

Abstract

This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures. A retrospective chart review was conducted at an academic trauma center. Patients ≥18 years treated for ballistic humeral shaft fractures (AO 1.2) between 2015 and 2022 were identified. Exclusion criteria included periarticular/intra-articular extension, non-ballistic mechanism, or age <18 years. Patients were stratified into operative versus nonoperative cohorts based on shared decision making. Outcome measures included time of union, postoperative visits, and reoperations. Time-to-event (TTE) analysis assessed duration of follow-up and time to healing. Discrete variables were compared for patients with >12 weeks follow-up using Fisher's exact tests and Student's t tests. Seventy-four patients (31 nonoperative, 43 operative) were included in TTE analysis. After excluding patients with <12 weeks follow-up, 43 patients (19 nonoperative, 24 operative) were included in discrete analysis (88% male, 86% Black, mean age 31 years). Operatively treated fractures included higher percentages of male patients (100% vs 71%, <i>P</i> < .01) and vascular injuries (25% vs 0%, <i>P</i> = .03), and a larger percentage of fractured humerus (21% vs 15%, <i>P</i> = .03). In TTE analysis, operative fractures demonstrated faster healing (<i>P</i> = .03). Nine patients (47%) in the nonoperative group underwent unplanned operations compared to two patients (8%) in the operative group (<i>P</i> < .01). No differences were found in follow-up visits or time to clinic discontinuation. Operatively treated ballistic humeral shaft fractures demonstrated faster healing and lower reoperation rates than nonoperatively treated ballistic fractures, despite association with more profound injury.