Functional bracing for the treatment of fractures of the humeral diaphysis

A. Sarmiento, J. B. Zagorski, Gregory A Zych, L. L. Latta, C. A. Capps

Research output: Contribution to journalArticle

224 Citations (Scopus)

Abstract

Background: Nonoperatively treated fractures of the humeral diaphysis have a high rate of union with good functional results. However, there are clinical situations in which operative treatment is more appropriate, and, though interest in plate osteosynthesis has decreased, intramedullary nailing has gained popularity in recent years. We report the results of treating fractures 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 humeral diaphysis were treated with a prefabricated brace that permitted motion of adjacent joints. The injured extremities were initially stabilized in an 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 prefabricated brace. Orthopaedic residents, supervised by teaching staff, provided follow-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 and seven (less than 2 percent) who had a closed fracture had a nonunion after bracing. In 87 percent of the 565 patients for whom anteroposterior radiographs were available, the fracture healed in less than 16 degrees of varus angulation, and in 81 percent of the 546 for whom lateral radiographs were available, it healed in less than 16 degrees of anterior angulation. At the time of brace removal, 98 percent of the patients had limitation of shoulder motion of 25 degrees or less. We were unable to follow most of the patients long- term, as they did not return to the clinic once the fracture had united and use of the brace had been discontinued. Conclusions: Functional bracing for the treatment of fractures of the humeral diaphysis is associated with a high rate of union, particularly when used for closed fractures. The residual angular deformities are usually functionally and aesthetically acceptable. The present study illustrates the difficulties encountered in carrying out long-term follow-up of indigent patients treated in charity hospitals that are affiliated with teaching institutions. These difficulties are also becoming common with patients insured under managed-care organizations and are frequent in our peripatetic population.

Original languageEnglish
Pages (from-to)478-486
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume82
Issue number4
StatePublished - Apr 1 2000

Fingerprint

Humeral Fractures
Diaphyses
Braces
Closed Fractures
Therapeutics
Teaching
Extremities
Joints
Charities
Intramedullary Fracture Fixation
Aftercare
Open Fractures
Splints
Managed Care Programs
Poverty
Elbow
Ambulatory Care Facilities
Orthopedics
Organizations

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Sarmiento, A., Zagorski, J. B., Zych, G. A., Latta, L. L., & Capps, C. A. (2000). Functional bracing for the treatment of fractures of the humeral diaphysis. Journal of Bone and Joint Surgery - Series A, 82(4), 478-486.

Functional bracing for the treatment of fractures of the humeral diaphysis. / Sarmiento, A.; Zagorski, J. B.; Zych, Gregory A; Latta, L. L.; Capps, C. A.

In: Journal of Bone and Joint Surgery - Series A, Vol. 82, No. 4, 01.04.2000, p. 478-486.

Research output: Contribution to journalArticle

Sarmiento, A, Zagorski, JB, Zych, GA, Latta, LL & Capps, CA 2000, 'Functional bracing for the treatment of fractures of the humeral diaphysis', Journal of Bone and Joint Surgery - Series A, vol. 82, no. 4, pp. 478-486.
Sarmiento, A. ; Zagorski, J. B. ; Zych, Gregory A ; Latta, L. L. ; Capps, C. A. / Functional bracing for the treatment of fractures of the humeral diaphysis. In: Journal of Bone and Joint Surgery - Series A. 2000 ; Vol. 82, No. 4. pp. 478-486.
@article{5489ea5943414071b5e3b16c333654fc,
title = "Functional bracing for the treatment of fractures of the humeral diaphysis",
abstract = "Background: Nonoperatively treated fractures of the humeral diaphysis have a high rate of union with good functional results. However, there are clinical situations in which operative treatment is more appropriate, and, though interest in plate osteosynthesis has decreased, intramedullary nailing has gained popularity in recent years. We report the results of treating fractures 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 humeral diaphysis were treated with a prefabricated brace that permitted motion of adjacent joints. The injured extremities were initially stabilized in an 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 prefabricated brace. Orthopaedic residents, supervised by teaching staff, provided follow-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 and seven (less than 2 percent) who had a closed fracture had a nonunion after bracing. In 87 percent of the 565 patients for whom anteroposterior radiographs were available, the fracture healed in less than 16 degrees of varus angulation, and in 81 percent of the 546 for whom lateral radiographs were available, it healed in less than 16 degrees of anterior angulation. At the time of brace removal, 98 percent of the patients had limitation of shoulder motion of 25 degrees or less. We were unable to follow most of the patients long- term, as they did not return to the clinic once the fracture had united and use of the brace had been discontinued. Conclusions: Functional bracing for the treatment of fractures of the humeral diaphysis is associated with a high rate of union, particularly when used for closed fractures. The residual angular deformities are usually functionally and aesthetically acceptable. The present study illustrates the difficulties encountered in carrying out long-term follow-up of indigent patients treated in charity hospitals that are affiliated with teaching institutions. These difficulties are also becoming common with patients insured under managed-care organizations and are frequent in our peripatetic population.",
author = "A. Sarmiento and Zagorski, {J. B.} and Zych, {Gregory A} and Latta, {L. L.} and Capps, {C. A.}",
year = "2000",
month = "4",
day = "1",
language = "English",
volume = "82",
pages = "478--486",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "4",

}

TY - JOUR

T1 - Functional bracing for the treatment of fractures of the humeral diaphysis

AU - Sarmiento, A.

AU - Zagorski, J. B.

AU - Zych, Gregory A

AU - Latta, L. L.

AU - Capps, C. A.

PY - 2000/4/1

Y1 - 2000/4/1

N2 - Background: Nonoperatively treated fractures of the humeral diaphysis have a high rate of union with good functional results. However, there are clinical situations in which operative treatment is more appropriate, and, though interest in plate osteosynthesis has decreased, intramedullary nailing has gained popularity in recent years. We report the results of treating fractures 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 humeral diaphysis were treated with a prefabricated brace that permitted motion of adjacent joints. The injured extremities were initially stabilized in an 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 prefabricated brace. Orthopaedic residents, supervised by teaching staff, provided follow-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 and seven (less than 2 percent) who had a closed fracture had a nonunion after bracing. In 87 percent of the 565 patients for whom anteroposterior radiographs were available, the fracture healed in less than 16 degrees of varus angulation, and in 81 percent of the 546 for whom lateral radiographs were available, it healed in less than 16 degrees of anterior angulation. At the time of brace removal, 98 percent of the patients had limitation of shoulder motion of 25 degrees or less. We were unable to follow most of the patients long- term, as they did not return to the clinic once the fracture had united and use of the brace had been discontinued. Conclusions: Functional bracing for the treatment of fractures of the humeral diaphysis is associated with a high rate of union, particularly when used for closed fractures. The residual angular deformities are usually functionally and aesthetically acceptable. The present study illustrates the difficulties encountered in carrying out long-term follow-up of indigent patients treated in charity hospitals that are affiliated with teaching institutions. These difficulties are also becoming common with patients insured under managed-care organizations and are frequent in our peripatetic population.

AB - Background: Nonoperatively treated fractures of the humeral diaphysis have a high rate of union with good functional results. However, there are clinical situations in which operative treatment is more appropriate, and, though interest in plate osteosynthesis has decreased, intramedullary nailing has gained popularity in recent years. We report the results of treating fractures 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 humeral diaphysis were treated with a prefabricated brace that permitted motion of adjacent joints. The injured extremities were initially stabilized in an 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 prefabricated brace. Orthopaedic residents, supervised by teaching staff, provided follow-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 and seven (less than 2 percent) who had a closed fracture had a nonunion after bracing. In 87 percent of the 565 patients for whom anteroposterior radiographs were available, the fracture healed in less than 16 degrees of varus angulation, and in 81 percent of the 546 for whom lateral radiographs were available, it healed in less than 16 degrees of anterior angulation. At the time of brace removal, 98 percent of the patients had limitation of shoulder motion of 25 degrees or less. We were unable to follow most of the patients long- term, as they did not return to the clinic once the fracture had united and use of the brace had been discontinued. Conclusions: Functional bracing for the treatment of fractures of the humeral diaphysis is associated with a high rate of union, particularly when used for closed fractures. The residual angular deformities are usually functionally and aesthetically acceptable. The present study illustrates the difficulties encountered in carrying out long-term follow-up of indigent patients treated in charity hospitals that are affiliated with teaching institutions. These difficulties are also becoming common with patients insured under managed-care organizations and are frequent in our peripatetic population.

UR - http://www.scopus.com/inward/record.url?scp=0034039882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034039882&partnerID=8YFLogxK

M3 - Article

C2 - 10761938

AN - SCOPUS:0034039882

VL - 82

SP - 478

EP - 486

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 4

ER -