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Original Research
Nonoperative Treatment of Closed Extra-Articular Distal Humeral Shaft Fractures in Adults: A Comparison of Functional Bracing and Above-Elbow Casting
Authors’ Disclosure Statement: Dr. Ring reports that he is a board or committee member of the American Academy of Orthopaedic Surgeons and the Orthopaedic Trauma Association; is on the editorial or governing board of Clinical Orthopaedics and Related Research and Journal of Orthopaedic Trauma; and receives intellectual property royalties from Skeletal Dynamics and Wright Medical Technology, Inc. The other authors report no actual or potential conflict of interest in relation to this article.
Dr. Swellengrebel is an Attending Surgeon, Haaglanden Medical Centre (HMC), The Hague, The Netherlands. Dr. Saper is an Attending Surgeon, Orthopaedic and Rehabilitation Centers, Chicago, Illinois. Dr. Yi is a Radiology Resident, Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Weening is an Attending Surgeon, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. Dr. Ring is Associate Dean for Comprehensive Care and Professor of Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas. Dr. Jawa is an Attending Surgeon, New England Baptist Hospital, Boston, Massachusetts.
Address correspondence to: David Saper, MD, 850 Harrison Ave., Dowling 2 North, Boston MA, 02118 (tel, 617-638-8934; fax, 888-267-7761; email, Dave.saper@gmail.com).
Am J Orthop. 2018;47(5). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
H.J. Christiaan Swellengrebel, MS David Saper, MD Paul Yi, MD Alexander A. Weening, MD David Ring, MD Andrew Jawa, MD . Nonoperative Treatment of Closed Extra-Articular Distal Humeral Shaft Fractures in Adults: A Comparison of Functional Bracing and Above-Elbow Casting. Am J Orthop.
May 15, 2018
References
No cost comparison was done between these 2 treatment modalities. However, both casting and bracing offer substantially lower costs comparted to surgical treatment with high efficacy and less risk for the patient. In some billing environments, closed treatments of fractures are captured as “surgical interventions” with global periods included in the reimbursement. Both casting and bracing are relatively inexpensive with materials that are readily accessible in nearly any general or subspecialty orthopedic practice.
There is a passive implication that operative treatment of distal third diaphyseal humerus fractures affords better results and union for patients in the discussed literature. Our results demonstrate that the distal diaphyseal humerus has a natural anatomic and biologic propensity to heal with closed immobilization. Patients should be made aware that while operative treatments exist for this fracture pattern, nonoperative treatment modalities have proven to be efficacious using a variety of immobilization methods. Thus, patients that prefer nonoperative treatment of a distal third diaphyseal humerus fracture can choose between a cast or a brace with confidence of the efficacy of the nonoperative treatment.
