Original Research

Nonoperative Treatment of Closed Extra-Articular Distal Humeral Shaft Fractures in Adults: A Comparison of Functional Bracing and Above-Elbow Casting

Publish date: May 15, 2018

References

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Four patients had concomitant injuries: one patient had a mid-shaft humeral fracture on the contralateral arm; a second had an ankle fracture; a third had an ankle fracture, acetabular fracture, a rib fracture, and pneumothorax; and the fourth had 2 rib fractures.

The patients who were treated with an AEC had an average age of 32 years (range,18-82 years) and included 14 men and 10 women. The cast was removed at an average of 4.2 weeks (range, 3-7 weeks) after the initial injury. Two patients had an injury-associated radial nerve palsy, both of which fully recovered. Five patients were injured due to a fall from standing height, 1 due to a fall from a height greater than standing, 7 during a motor-vehicle accident, 5 during a sport activity, and 6 were not documented. Two patients sustained concomitant injuries: one patient sustained a tibia-fibula fracture, and another patient sustained facial trauma.

The 2 groups were comparable in age and gender, as well as the injury mechanism (Table).

Table. Patient Demographics and Outcome Data

	Functional Bracing (n = 51)	Long Arm Casting (n = 24)	Significance (P < .05)
Sex
Male	27 (54%)	14 (58%)
Female	24 (46%)	10 (42%)
Average age (y)	34 (range, 18-90)	32 (range, 18-82)
Mechanism of injury
Standing height	16 (31%)	5 (20%)
Greater height	2 (4%)	1 (4%)
Motor vehicle collision	16 (31%)	7 (29%)
Sports activity	15 (29 %)	5 (21%)
Other	2 (4%)	6 (25%)
Follow-up (months)	7 (range, 2-25)	4 (range, 2-15)
Elbow range of motion (degrees)	130 ± 9.4	127 ± 11.9	P = .26
Varus/valgus angulation (degrees)	17 ± 7.8 varus	13 ± 8.4 varus	P = .11
Anterior/posterior angulation (degrees)	9 ± 6.2 posterior	7 ± 7.5 posterior	P = .54

FUNCTIONAL BRACING TECHNIQUE

Upon presentation after injury, patients were immobilized in a coaptation splint (Figure 1A). Within 10 days, the arm was placed in a pre-manufactured polyethylene functional brace (Corflex) and the arm was supported with a simple sling. Patients were allowed to use the hand for light tasks and move the elbow, but most patients were not capable of active elbow flexion exercises until early healing was established 4 to 6 weeks after injury. Shoulder motion was discouraged until radiographic union. Patients started active, self-assisted elbow and shoulder stretching exercises, and weaned from the brace once radiographic union was confirmed between 6 and 10 weeks after injury (Figures 1B, 1C).

ABOVE-ELBOW CASE

Patients were also initially immobilized in a coaptation splint upon initial presentation. Within 7 days, an above-elbow fiberglass cast with neutral forearm rotation and 90° of elbow flexion was applied with a supracondylar mold, followed by radiographic imaging (Figure 2A). With the fractured arm dependent, a valgus mold was applied as the material hardened in order to align the fracture site and limit varus angulation.

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