Functional bracing for the treatment of fractures of the humeral diaphysis

Background: Nonoperatively treated fractures of the hmneral diaphysis have a high rate of union with good functional results. However, there are clini cal situations in which operative treatment is more appropriate, and, thoug h interest in plate osteosynthesis has decreased, intramedullary nailing ha s gained popularity in recent years. We report the results of treating frac tures of the humeral diaphysis with a prefabricated brace that permits full motion of all joints and progressive use of the injured extremity. Methods: Between 1978 and 1990, 922 patients who had a fracture of the hume ral diaphysis were treated with a prefabricated brace that permitted motion of adjacent joints, The injured extremities were initially stabilized in a n above-the-elbow cast or a coaptation splint for an average of nine days ( range, zero to thirty-five days) prior to the application of the prefabrica ted brace, Orthopaedic residents, supervised by teaching staff, provided fo llow-up care in a special outpatient clinic. Radiographs were made at each follow-up visit until the fracture healed. Results: We were able to follow 620 (67 percent) of the 922 patients, Four hundred and sixty-five (75 percent) of the fractures were closed, and 155 ( 25 percent) were open. Nine patients (6 percent) who had an open fracture a nd seven (less than 2 percent) who had a closed fracture had a nonunion aft er bracing. In 87 percent of the 565 patients for whom anteroposterior radi ographs were available, the fracture healed in less than 16 degrees of varu s angulation, and in 81 percent of the 546 for whom lateral radiographs wer e available, if healed in less than 16 degrees of anterior angulation. At t he time of brace removal, 98 percent of the patients had limitation of shou lder motion of 25 degrees or less. We were unable to follow most of the patients long-term, as they did not re turn to the clinic once the fracture had united and use of the brace had be en discontinued. Conclusions: Functional bracing for the treatment of fractures of the humer al diaphysis is associated,with a high rate of union, particularly when use d for closed fractures, The residual angular deformities are usually functi onally and aesthetically acceptable. The present study illustrates the diff iculties encountered In carrying out long-term follow-up of indigent patien ts treated in charity hospitals that are affiliated with teaching instituti ons. These difficulties are also becoming common with patients insured unde r managed-care organizations and are frequent in our peripatetic population .