Modern closed treatment methods rely substantially on the effect of gravity to achieve proper position of the fracture.
Hanging Cast
With the elbow bent at 90 degrees, a long arm cast is placed and upper part of the cast is molded carefully to align the humeral fracture. The cast must be lightweight or distraction may occur at the fracture site that may interfere with union of the fracture site. A series of loops are incorporated into the cast at the junction of the middle and distal thirds of the forearm.
After application, the cast is then suspended by a strap around the neck connected to the loops on the cast.
By changing the position at which the strap connects to the loops, the alignment of the fracture can be adjusted.
- Proximal and distal adjustments change anterior and posterior angulation,
- Volar and dorsal adjustments change varus and valgus alignment.
The arm must remain dependent at all times all the times. The patient should be sleeping in Fowler’s semireclining position, and while sitting, the patient should avoid support under the elbow. Distraction and poor healing is a complication with this technique.
One of the better methods is functional bracing.
U-splinting
This method can be used for temporary or definitive treatment. It involves placement of a well molded plaster slab from the axilla, around the elbow, and over the deltoid with the elbow flexed to 90 degrees. A collar-and-cuff suspension sling supports the forearm. This method has less tendency for distraction as compared to hanging cast.
For definitive treatment it is effective, functional bracing method perform better.
Humeral fracture orthosis
Humeral fracture orthosis is the preferred method of non operative treatment of fracture humer. A rigid, light-weight plastic brace composed of an anterior and posterior shell joined by Velcro straps. A flare extending over the deltoid with an additional strap meant to extend around the thorax may prevent the brace from slipping distally.
A coaptation splint may be applied initially, with placement of the orthosis delayed for 7 to 14 days.
When fitted properly, the splint extends from the axilla medially to a position as far distal as possible without limiting motion of the elbow joint.
Straps help to adjust he brace and prevent from slipping.
In earlsy period of treatment, a collar-and-cuff type of suspension strap connected to the wrist.
The patient should be sleeping in Fowler’s semireclining position, and while sitting, the patient should avoid support under the elbow
As healing progresses, the patient is encouraged to do active range-of-motion exercises of the elbow joint as well as pendulum and circumduction exercises of the shoulder as pain allows.
The position of the fracture fragments must be verified at 1 week and again at 2 weeks after fracture. Radiographs should be checked every 3 to 4 weeks during healing until the fracture is clinically and radiographically united. Bracing should be continued for at least 8 weeks to prevent refracture.
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The above narration could have contained some photos as well; of the hanging cast, U slab and the cast brace
Dr Arun Pal Singh Reply:
February 18th, 2010 at 2:49 pm
@Dr V M Iyer,
You are very right. But I did not have those at the time I wrote and therefore went ahead with text.
I am not comfortable with using copyrighted images and it is not always possible to obtain a permission.
May be some time in future.