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.