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Three Part Question

In [elderly patients with uncomplicated shaft of humerus fractures] is [a u-slab, a hanging cast or a collar and cuff] better at [reducing pain and promoting healing]?

Clinical Scenario

A 60 year old woman presents with a closed, undisplaced, uncomplicated fracture of the shaft of the humerus. You seek advice on the best method to support / splint the arm and receive a range of different answers. You wonder whether there is any evidence to suggest that any one method is the best.

Search Strategy

Medline using the OVID interface 1950 to November Week 2 2007
The Cochrane Library Issue 4 2007
Medline:[exp Fractures, Bone/ OR exp fractures, closed/ OR exp fractures, stress/ OR exp humeral fractures/ OR exp shoulder fractures/ OR fracture$.mp. AND humerus.mp. or exp Humerus/] AND [sling.mp. OR slab.mp. OR exp casts, surgical/ OR exp splints OR plaster$.mp. OR collar and cuff.mp.] LIMIT to human AND English language, LIMIT to middle age 45 plus years
Cochrane: Shoulder fractures [Mesh] explode all trees

Search Outcome

47 papers found in Medline and 16 in the Cochrane Library, but none were relevant to the question asked.

Comment(s)

There is no properly designed head to head evidence to answer the three part question. A properly designed trial may be warranted given that these fractures are common and painful.

Clinical Bottom Line

There is no evidence to indicate whether a u-slab, a hanging cast or a collar and cuff is better at minimizing pain and maximizing healing in elderly patients with shaft of humerus fractures. Local advice should be followed.