Functional and clinical outcome after operative versus nonoperative treatment of a humeral shaft fracture (HUMMER): results of a multicenter prospective cohort study

Dennis Den Hartog, Saskia H. Van Bergen, the HUMMER Investigators, Kiran C. Mahabier, Michael H.J. Verhofstad, Esther M.M. Van Lieshout*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
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Purpose: The best treatment of humeral shaft fractures in adults is still under debate. This study aimed to compare functional and clinical outcome of operative versus nonoperative treatment in adult patients with a humeral shaft fracture. We hypothesized that operative treatment would result in earlier functional recovery. Methods: From October 23, 2012 to October 03, 2018, adults with a humeral shaft fracture AO type 12A or 12B were enrolled in a prospective cohort study in 29 hospitals. Patients were treated operatively or nonoperatively. Outcome measures were the Disabilities of the Arm, Shoulder, and Hand score (DASH; primary outcome), Constant–Murley score, pain (Visual Analog Score, VAS), health-related quality of life (Short Form-36 (SF-36) and EuroQoL-5D-3L (EQ-5D)), activity resumption (Numeric Rating Scale, NRS), range of motion (ROM) of the shoulder and elbow joint, radiologic healing, and complications. Patients were followed for one year. Repeated measure analysis was done with correction for age, gender, and fracture type. Results: Of the 390 included patients, 245 underwent osteosynthesis and 145 were primarily treated nonoperatively. Patients in the operative group were younger (median 53 versus 62 years; p < 0.001) and less frequently female (54.3% versus 64.8%; p = 0.044). Superior results in favor of the operative group were noted until six months follow-up for the DASH, Constant–Murley, abduction, anteflexion, and external rotation of the shoulder, and flexion and extension of the elbow. The EQ-US, and pronation and supination showed superior results for the operative group until six weeks follow-up. Malalignment occurred only in the nonoperative group (N = 14; 9.7%). In 19 patients with implant-related complications (N = 26; 10.6%) the implant was exchanged or removed. Nonunion occurred more often in the nonoperative group (26.3% versus 10.10% in the operative group; p < 0.001). Conclusion: Primary osteosynthesis of a humeral shaft fracture (AO type 12A and 12B) in adults is safe and superior to nonoperative treatment, and should therefore be the treatment of choice. It is associated with a more than twofold reduced risk of nonunion, earlier functional recovery and a better range of motion of the shoulder and elbow joint than nonoperative treatment. Even after including the implant-related complications, the overall rate of complications as well as secondary surgical interventions was highest in the nonoperative group. Trial registration: NTR3617 (registration date 18-SEP-2012).

Original languageEnglish
Pages (from-to)3265-3277
Number of pages13
JournalEuropean Journal of Trauma and Emergency Surgery
Issue number4
Early online date9 Feb 2022
Publication statusPublished - Aug 2022

Bibliographical note

Funding Information:
Saskia H. Van Bergen, Kiran C. Mahabier, and Michael H.J. Verhofstad declare that they have no conflict of interest. Dennis Den Hartog and Esther MM Van Lieshout have received financial support from the OTC Foundation for the submitted work.

Funding Information:
This project was supported by a grant from the Osteosynthesis and Trauma Care (OTC) Foundation (reference number 2013-DHEL). This organization was not involved in the study design, patient recruitment, data collection, data analysis, data interpretation, publication decisions, or in any aspect pertinent to this study.

Publisher Copyright:
© 2022, The Author(s).


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