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Humeral fracture bracing

From: "Functional Fracture Bracing" - Augusto Sarmiento, M.D., Steven D.K. Ross, M.D., Walter L. Racette, C.P.O.

Fracture bracing of the humerus allows for early range of motion and muscle activity and therefore reduces or eliminates the sequelae of immobilization and inactivity. l9 Minor angulatory deformities that frequently occur do not constitute a functional deficit. A few degrees of angulation at the fracture site are difficult to detect and thus are not cosmetically unsightly. Shortening of the humeral shaft that has been observed in a few instances is also of no clinical significance. Most angulating deformities occur in the varus plane, and their severity is usually greater close to the elbow joint. Rotational deformities, as a rule, have been minimal and represent loss of external rotation caused by a slight amount of internal rotation at the fracture site or minor loss of external rotation within the shoulder. They are usually mild and of no clinical significance. The firm compression of soft tissues by the plastic sleeve helps to align the fracture while providing enough immobilization to allow early function. Gravity, along with the dynamic corrective forces of the elbow flexors and extensors, tends to align the fracture.

Initial Treatment Plan

The initial treatment of closed fractures of the humerus consists of stabilization of the extremity in casts, splints, or slings to provide comfort, correct major deformities, and protect the injured extremity. Because of the likelihood of varus angulation, especially in distal fractures, the forearm should be held in pronation. It is rarely necessary to manipulate humeral fractures to obtain adequate alignment. As soon as the acute symptoms of the fracture begin to subside, it is desirable to institute gravity dependent pendulum exercises for the shoulder to prevent disabling adhesive capsulitis. Particularly in elderly patients, adhesive capsulitis may cause disability for a longer time than is required for healing of the fracture. In addition to shoulder exercises, activity of the forearm and hand musculature is also recommended. since this will expedite overall recovery and reduce swelling.

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