Functional cast bracing in closed fractures of shaft of humerus

Abstract

Background: Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. We evaluated clinical, radiographic, and functional results of patients treated with functional bracing for humeral shaft fractures. Materials and Methods: This clinical study was done at a tertiary care teaching hospital, Durgapur, West Bengal. Approval from the Institutional ethics committee was obtained and written informed consent from the patient was taken. Sixteen cases of unilateral, closed humeral shaft fractures involving ten right arm and six left arm cases were included in this study, during April 2018 to March 2019. Only simple, closed diaphysial fractures were selected. Initially, fractures were stabilized by hanging cast for 7 to 10 days. Analgesic & anti inflammatory drugs (NSAIDS) were advised. Patients were called on 10th days for application of cast brace. Patient was made to sit on a stool. Hanging cast was removed. A thin layer of cotton padding was applied around his arm extending from shoulder to elbow. Now plaster cast was applied extending from just below the acromion and 2 cm. below the axilla to 1.5 cm above the medial epicondyle and laterally above lateral epicondyle. Gentle traction was applied and minor correction of alignment was done. Plaster cast was snugly applied so that it was neither tight nor loose and carefully moulded to match the contour of the limb. Cuff and collar sling was given with elbow at 90®. Patient was tanght to do active exercise of shoulder, elbow and wrist. Cases were followed up at 6, 8, & 10 weeks. Each patient was thoroughly examined and findings noted. Clinical union was concluded as no pain and motion at fracture site coupled with radiological evidence of callus formation at fracture site. Results: Total no. of cases was 16. Majority of the cases in the age group of 21-40 yrs (53.2%) followed by 41-60 yrs [29.3%]. About 62.5% cases right sides in comparison to 37.5% were left sided humeral shaft fractures. Cases of humeral shaft fractures were more common in males (75%) in comparison to females (25%). About 62.5% cases middle third involvement in comparison to 25% were lower third humeral shaft fractures. About 37.5% cases were oblique fractures followed by 31.3% transverse and 18.7% spiral. About 62.5% cases were due to road traffic accidents [RTA] followed by 25.5% fall and 12% direct violence. About 75% cases were time of union followed noted 8-10 weeks by 25% cases time of union noted ≥12 weeks. Excellent means firm bony union without deformity and no limitation of motion and noted in 31.2% cases. Good means firm bony union, no functional impairment for ordinary purpose angulation not more than 10® and noted in 37.5% cases. Fair means firm bony union with occasional mild pain, limitation of motion in adjacent joint of more than 20% and angulation of more than 10® and recorded in 18.7% cases. Poor means persistent pain, limitation of motion in adjacent joints of 40% and with malunion non-union and impairment of function which was observed in 12.6% cases humerus fractures. Conclusion: About 16 cases were taken up for study and were followed up for 4-8 months form time since lnjury. Early functional activity with early restoration of joint movement reduced the period of rehabilitation considerably and the patient could resume their activities much earlier than those treated with other forms of conservative treatment. With these promising results, we hope to recruit more patients in a future prospective randomised trial, comparing our brace with other products or treatment interventions, with intent to demonstrate that our custom functional brace is economic, better tolerated by patients, and effective in treating humeral shaft fractures.