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

Background: This study compared fracture healing and reoperation rates between early operative versus nonoperative management of ballistic humeral shaft fractures. Materials and Methods: 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. Results: 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%, P < .01) and vascular injuries (25% vs 0%, P = .03), and a larger percentage of fractured humerus (21% vs 15%, P = .03). In TTE analysis, operative fractures demonstrated faster healing ( P = .03). Nine patients (47%) in the nonoperative group underwent unplanned operations compared to two patients (8%) in the operative group ( P < .01). No differences were found in follow-up visits or time to clinic discontinuation. Conclusion: Operatively treated ballistic humeral shaft fractures demonstrated faster healing and lower reoperation rates than nonoperatively treated ballistic fractures, despite association with more profound injury.