Risk factors associated with failure of treatment of humeral diaphyseal fractures after functional bracing.

Objectives: To assess humeral shaft nonunions after functional bracing and to identify any risk factors contributing to this outcome.

Materials And Methods: Seven men and 12 women were retrospectively studied that had been treated for at least three months in a functional brace and had developed a clinical and radiographic nonunion. Patients' charts and radiographs were reviewed to evaluate fracture patterns, mechanisms of injury, associated health problems, and associated injuries.

Results And Conclusions: The results indicate a trend toward nonunion in patients with the following risk factors: obesity (37%); a history of cigarette smoking (53%); metabolic bone disease (32%); cardiovascular disease (37%); short oblique fractures (89%); open fractures (26%); and fractures of the proximal third of the diaphysis (68%). We recommend counseling these patients on the possible increased risk of nonunion from functional bracing and considering the option of operative fixation.