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].
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.
Medline 1966 1950 to February Week 2 2007
Embase 1980 to 2007 Week 08. Using the OVID interface
The Cochrane Library Issue 1 2007
[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
9 due to application of limits papers were found all of which were relevant but only 2 addressed the specific question.
|Author, date and country
||Study type (level of evidence)
|Sharma et al,|
|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
|Varus angulation of less than 5 degrees.||16% vs 50%|
|Camden P. Nade S,|
|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
|Final alignment of the fracture||No difference|
|Range of elbow motion at the time of union||Greater in functional brace group|
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.
Clinical Bottom Line
Fracture bracing is as effective as or even superior to U-slabbing in the treatment fractures of the humeral shaft.
- Sharma VK. Jain AK. Gupta RK. Tyagi AK. Sethi PK. Non operative treatment of fractures of the humeral sfaft: a comparative study. Journal of the Indian Medical Association 1991;89(6):157-160.
- Camden P. Nade S. Fracture bracing the humerus. Injury. 1992;23(4):245-8.