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U cast or functional bracing following fractures of the shaft of humerus

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] 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,
65 cases of humeral shaft fracture 40 were treated by functional cast bracing vs 25 patients treated by U cast method.Controlled trialAverage time taken for union was7.5 weeks vs 10 weeksSmall sample size. Age of patients not considered Not randomised
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 braceControlled trialHealing timeNo differenceSmall sample size Not randomised
Final alignment of the fractureNo difference
Range of elbow motion at the time of unionGreater 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.


  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.