• 
• 

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
[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

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Sharma et al, 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%
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

Comment(s)

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.

References

1. 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.
2. Camden P. Nade S. Fracture bracing the humerus. Injury. 1992;23(4):245-8.