Session IX - Upper Extremity

Sat., 10/12/13 Upper Extremity, PAPER #97, 2:26 pm OTA 2013

Nonoperative Treatment of Closed Extra-Articular Distal-Third Diaphyseal Fractures of the Humerus: A Comparison of Functional Bracing and Long Arm Casting

H.J. Christiaan Swellengrebel, MS1; David Saper, MD2; Paul Yi, BS2; Ryan Shin, MD2;
David Ring, MD, PhD1; Andrew Jawa, MD2;
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital,
Boston, Massachusetts, USA;
2Department of Orthopaedic Surgery, Boston University Medical Center,
Boston, Massachusetts, USA

Background/Purpose: Advocates of functional bracing for nonoperative treatment of distal-third diaphyseal humerus fractures are concerned that long arm casting may cause elbow stiffness, while advocates of long arm casting claim superior alignment. We performed a retrospective comparison of these two nonoperative treatment methods.

Methods: 105 consecutive patients with a closed, extra-articular fracture of the distal third of the humeral diaphysis were identified from two orthopaedic trauma databases between 2003 and 2011. 80 patients were followed until healing and near full motion, to surgery for nonunion, or at least 6 months otherwise. 51 patients managed with functional bracing and 24 patients managed with long arm casting had adequate follow-up. Elbow range of motion and radiographic alignment of the humerus at the last follow-up were compared between the two treatment groups using the Student t test.

Results: All of the fractures healed. The average arc of elbow flexion was 130° ± 9.4° in braced patients versus 127° ± 11.9° in casted patients (P = 0.26). Four (8%) patients in the bracing group and four (17%) in the casting group had lost >20° of elbow motion. The average varus-valgus angulation was 17° ± 7.8° versus 13° ± 8.4°, respectively (P = 0.11) and the average anterior-posterior angulation was 9° ± 6.2° versus 7° ± 7.5° (P = 0.54), respectively.

Conclusion: For closed extra-articular distal-third humeral fractures, both functional bracing and long arm casting have a 100% union rate and there are no differences in average elbow motion or radiographic alignment.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.