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