U cast or functional bracing following fractures of the shaft of humerus
Date First Published:
April 2, 2002
Last Updated:
March 20, 2007
Report by:
Ian J. Persad, SHO Orthopaedics (Darlington Memorial Hospital)
Search checked by:
Sashi Kommu, Darlington Memorial Hospital
Three-Part Question:
In [patients with fracture shaft of humerus] is [functional bracing as effective as U-slab/cast] at [reducing pain and complications of fracture healing].
Clinical Scenario:
You are seeing a patient in the A&E department with a fracture shaft of humerus.You have never applied a U-slab before and wonder if applying a brace instead would be detrimental to the healing of the fracture.
Search Strategy:
Medline 1966 1950 to February Week 2 2007
Embase 1980 to 2007 Week 08. Using the OVID interface
The Cochrane Library Issue 1 2007
Embase 1980 to 2007 Week 08. Using the OVID interface
The Cochrane Library Issue 1 2007
Search Details:
[exp Humeral Fractures/] AND [exp Braces/] AND [exp Casts, Surgical/ or casts.mp.] Limit to human and English Language
Cochrane:Humerus [MeSH] explode all trees 41 records 0 relevant
Cochrane:Humerus [MeSH] explode all trees 41 records 0 relevant
Outcome:
9 due to application of limits papers were found all of which were relevant but only 2 addressed the specific question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Non operative treatment of fractures of the humeral sfaft: a comparative study. Sharma VK. Jain AK. Gupta RK. Tyagi AK. Sethi PK. 1991, India | 65 cases of humeral shaft fracture 40 were treated by functional cast bracing vs 25 patients treated by U cast method. |
Controlled trial | Average time taken for union was | 7.5 weeks vs 10 weeks | Small sample size. Age of patients not considered Not randomised |
| Varus angulation of less than 5 degrees. | 16% vs 50% | ||||
| Fracture bracing the humerus. Camden P. Nade S. 1992, Australia | A group of patients treated with a plaster U slab were matched for type and level of fracture with a group treated with a humeral brace | Controlled trial | Healing time | No difference | Small sample size Not randomised |
| Final alignment of the fracture | No difference | ||||
| Range of elbow motion at the time of union | Greater in functional brace group |
Author Commentary:
Initiating management of humeral fractures can be very daunting to the inexperienced casualty officer. This is especially so since the proper application of a U-slab comes with practice and is extremely difficult if not impossible in the obese patient.
Bottom Line:
Fracture bracing is as effective as or even superior to U-slabbing in the treatment fractures of the humeral shaft.
References:
- Sharma VK. Jain AK. Gupta RK. Tyagi AK. Sethi PK.. Non operative treatment of fractures of the humeral sfaft: a comparative study.
- Camden P. Nade S.. Fracture bracing the humerus.