Session VI Upper Extremity

Saturday, September 28, 1996 Session VI, 4:32 p.m.

Diaphyseal Humeral Fractures - A Report on 377 Patients Treated with Functional Braces

Augusto Sarmiento, MD, Catherine Capps, MD, Loren L. Latta, PhD

Coral Gables, FL

Hypothesis: Functional use of the injured extremity of patients with diaphyseal humeral fractures stabilized in "functional sleeves" encourages osteogenesis, maintains acceptable alignment of fragments and preserves joint motion.

Conclusions: Functional bracing of diaphyseal humeral fractures renders satisfactory clinical and radiological results in a high percentage of instances.

Material and Methods: 377 patients with diaphyseal humeral fractures were treated with prefabricated functional braces which were applied within the first two weeks following the injury. 32% of the fractures were produced by falls; 34% from vehicular accidents; 18% by gunshot wounds and 16% from other causes. 77% were closed and 23% were open. 17% of the fractures were associated with initial peripheral nerve palsy. All patients were initially treated with stabilizing long arm casts or coaptation splints and were encouraged to carry out pendulum exercises of the shoulder as soon as possible. Upon disappearance of acute symptoms, a prefabricated brace was applied. The braces covered only the diaphyseal of the humerus, were circular and adjustable with Velcro strips. The Velcro strips were tightened on a regular basis to accommodate the reduction of edema and developing muscle atrophy. Passive exercises of the shoulder and passive and active exercises of the elbow were encouraged. A collar and cuff was used initially and was discontinued as passive extension of the elbow became complete and the symptoms were minimal. Patients were evaluated approximately every four weeks. Anatomical deviations were measured on roentgenogram and recorded. Range of motion was also measured and recorded.

Results: There was an incidence of nonunion of 2.6 %. 1.6% of the patients had varus angulation greater than 25° upon completion of healing. 19.7 % had between 5 - 10° of varus, 12.7% between 11 - 15° and 8.3% between 10 - 25°. 57.7% of the patients had no limitation of motion of the shoulder, 27% to 10°; 12.3% between 10 - 25° and 2.6% more than 25°. Two refractures occurred, but healed in the brace.