ADVERTISEMENT

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

May 15, 2018 | Surgery
H.J. Christiaan Swellengrebel, MS ; David Saper, MD ; Paul Yi, MD ; Alexander A. Weening, MD ; David Ring, MD ; Andrew Jawa, MD
Author and Disclosure Information

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

TAKE-HOME POINTS

  • Closed extra-articular distal diaphyseal humerus fractures heal predictably with both bracing and casting.
  • There are no differences in average elbow motion between bracing and casting of these fractures.
  • There are no differences in radiographic alignment between bracing and casting of these fractures.
  • The distal diaphyseal humerus has a natural anatomic and biologic propensity to heal with closed immobilization.
  • Patients preferring nonoperative treatment can choose between a cast or a brace with confidence of the efficacy of either treatment.

There were no shoulder ROM restrictions. Casts were removed, skin checked, and replaced every week for 4 to 6 weeks. Casts were removed when callus was noted on radiographs. After cast removal, physician-taught active and active-assisted elbow stretching exercises were given to patients to be performed on a daily basis at home. Patients were followed until clinical and radiographic union and elbow ROM to within 10° of the injured arm (Figures 2B, 2C).

STATISTICAL ANALYSIS

Alignment of the humerus (including varus-valgus alignment and apex anterior-posterior alignment) was measured on anteroposterior and lateral radiographs as the angle between lines bisecting the humeral diaphysis proximal and distal to the fracture. The normality of the data was tested using the Kolmogorov-Smirnov test. To statistically compare continuous variables with a normal distribution, t-tests were used; otherwise the Wilcoxon t-test was applied. The Pearson’s Chi-Square test was used to statistically compare dichotomous variables, except when expected cell frequency was <5, in which case the Fisher exact test was used. The level of significance was set at P < .05.

RESULTS

RANGE OF MOTION AND RADIOGRAPHIC ALIGNMENT

The average range of elbow motion was 130° ± 9° after brace treatment and 127° ± 12° after cast treatment (P = .26). Four patients (8%) treated with a brace and 3 (12%) treated with a cast lost >20° of elbow motion.

All the fractures healed. The average varus angulation on the anteroposterior radiograph was 17° (range, 2°-26°) in braced patients and 13 (range, 5°-31°) in casted patients (P = .11). The average posterior angulation on the lateral radiograph was 9° (range, 0°-28°) in braced patients vs 7° (range, 2°-33°) in casted patients (P = .54).

Continue to: Two weeks after initiating brace...

ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT