Objectives: To assess the presence of fracture site gross motion on physical examination to predict humeral shaft fracture progression to nonunion in patients managed non-operatively.

Design: Retrospective cohort study

Setting: Single trauma level 1 institutional center

Patients: Eighty-four consecutive patients undergoing non-operative treatment of a diaphyseal humeral shaft fracture were identified. The average age of the population was 48.3 years and 50% of the cohort was male.

Intervention: Clinical exam for fracture stability was routinely performed on patients by the treating physicians and documented it in the medical record. Patients were followed until union or surgery for persistent fracture mobility

Main Outcome Measurements: Stability was graded if there was motion at the site (1: motion of any kind 0: moved as a unit)

Results: Seventy-three patients (87%) healed their fracture within our study cohort by 6 months post-fracture. Of the remaining eleven patients, after discussion with their treating physicians about the option of surgical intervention, eight chose to undergo ORIF at an average of 8 months, one proceeded non-surgical interventions, and two were lost of follow-up. If the humeral shaft fracture site was mobile at 6 weeks follow-up visit, it identified future fracture nonunion with 82% sensitivity and 99% specificity (only one patient with motion at 6 weeks proceeded to fracture union).

Conclusion: With a high negative predictive value, clinical examination of fracture motion at 6 weeks should be assessed in every patient to determine which patients should obtain closer follow-up for risk of nonunion progression. Knowledge of gross fracture motion can be used in the shared decision making model in counseling about early surgical options.

Level of Evidence: Prognostic Level III Study

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