Surgical versus non-surgical interventions for treating humeral shaft fractures in adults

The humerus is the long bone of the upper arm. It extends from the shoulder to the elbow. The incidence of fractures of the middle part (shaft) of the humerus increases with age. Patients with this fracture can often be treated without surgery. Only a few patients need surgery. This review aimed to examine the evidence from best quality (randomised controlled) trials that compared surgical with non-surgical treatment of humeral fractures to determine if either treatment gives a better outcome. Despite an extensive search for evidence, the review authors found no evidence from completed randomised controlled trials to help inform the choice between surgical and non-surgical treatment.

Authors' conclusions: 

There is no evidence available from randomised controlled trials to ascertain whether surgical intervention of humeral shaft fractures gives a better or worse outcome than no surgery. Sufficiently powered good quality multi-centre randomised controlled trials comparing surgical versus non-surgical interventions for treating humeral shaft fractures in adults are needed. It is likely that the results from the two ongoing randomised trials on this topic will help inform practice in due course.

Read the full abstract...

Fractures of the shaft of the humerus account for 1% to 3% of all fractures in adults. The management of these fractures, including surgical intervention, varies widely.


To assess and compare the effects of surgical versus non-surgical intervention for non-pathological fractures of the humeral shaft in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, trial registers, and bibliographies of trial reports. The full search was conducted in October 2011.

Selection criteria: 

Considered for inclusion were all randomised and quasi-randomised (method of allocating participants to a treatment which is not strictly random; e.g. by date of birth, hospital record number or alternation) controlled trials that compared surgical with non-surgical intervention for humeral shaft fractures in adults.

Data collection and analysis: 

Two authors independently selected and assessed potential eligible studies for inclusion.

Main results: 

We found six completed studies that appeared to meet our inclusion criteria. After scrutiny, we excluded all six studies: five were retrospective studies and one was a prospective study without randomisation. We identified three potentially eligible ongoing studies, two of which involve randomisation of treatment allocation and one, which we excluded, that does not.