FISH

Effect of Surgery vs Functional Bracing on Functional Outcome Among Patients With Closed Displaced Humeral Shaft Fractures: The FISH Randomized Clinical Trial

Rämö L, Sumrein BO, Lepola V, et al. JAMA 2020 · PMID 32396179 · doi:10.1001/jama.2020.3182

Question

In adults with closed displaced humeral shaft fractures, does surgical fixation give better function than functional bracing?

Design

RCT in two university hospital trauma centres in Finland.

Patients

Adults with a closed, unilateral, displaced humeral shaft fracture, excluding multiple trauma and multimorbidity.

Intervention

Open reduction and plate fixation

Comparison

Functional bracing

Primary outcome

DASH score at 12 months

Key result

There was no clinically important difference in DASH at 12 months; bracing had a higher non-union rate, with some patients later converted to surgery.

Limitations

Small sample from two centres and not blinded; patients with multiple injuries were excluded.

Impact on practice

Supports functional bracing as first-line treatment for most isolated humeral shaft fractures, while counselling patients about the risk of non-union and delayed surgery.