EVALUATION OF RESULTS OF NON OPERATIVE TREATMENT OF FRACTURE SHAFT OF THE HUMERUS WITH A FUNCTIONAL BRACE

Abstract

Introduction: Fractures of the humeral shaft account for roughly 3% of all fractures due to fall on the outstretched hand, motor vehicle accidents and direct loads to the arm. The brace effectively compresses the bulky biceps and triceps muscle allowing early shoulder, elbow, wrist and hand motion with nonunion and radial nerve palsy in a signicant percentage of humeral shaft fractures. This study intends to assess the results of non-operative treatment of fracture shaft of the humerus with a functional brace. Materials and Methods: Prospective observational study was conducted in NMCTH, Birgunj among 50 patients from 16 years onwards of age who presented with fracture of humerus shaft. The patients with open fracture, oating elbow, bilateral humeral fracture, polytrauma, pathological fracture, additional injury of the extremities and patients with neurologic and psychiatric disorders were excluded from the study. The patients were treated with close reduction and immobilization in functional humeral cast brace and were followed up in outpatient department basis once a week for the rst four weeks and every four weeks subsequently till fracture united. After removal of brace functional evaluation of results of upper limb was done according to Hunter's criteria. RESULTS: Six patients out of 50 lost to follow up and was removed from nal analysis . Out of 44 cases, mean age of patient was 34.77 year. Most of them 28(64%) were male. RTA was most common mode of injury 24(54%). Most of the patient 26(59%) had rd fracture on non dominant side. Majority of the fractures 24(55%) were in the middle 1/3 . Thirty two cases (72%) attended the hospital within 24 hours of injury. Union was achieved in 41(93%) patients within a mean time of 11.48 weeks. One transverse and two comminuted fractures in middle and distal third of diaphysis did not unite and were treated surgically. According to Hunter's criteria of evaluation of results, 31(75.6%) of united fractures had excellent (G5) and 10(24.4%) had good (G4) results. Restriction of few degrees of terminal range of movements of shoulder abduction and external rotation present initially improved subsequently after physiotherapy. Mean varus angulation in 39 patients at the time of removal of brace was 7.05° and mean valgus angulation in four patients was 6.00°. Mean anterior angulation of 6.85° was present in 21 patients and mean posterior angulation of 7.11° was present in 20 patients at the time of removal of brace. Mean shortening of 6.5 mm was present in 36 patients. The various angulation deformities and shortening at the end of union did not cause functional and cosmetic effect. Conclusion: Fracture shaft of humerus treated by close reduction and functional bracing has good functional outcomes.