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Continue current splint for 6 weeks
3%
78/2816
Continue current splint for 3 weeks and transition to hanging arm sling for additional 3 weeks
6%
163/2816
Transition to functional brace for additional 6-8 weeks
87%
2460/2816
Open reduction internal fixation with compression plating
93/2816
Staged procedure with humeral external fixator, then open reduction internal fixation with compression plating
0%
3/2816
Select Answer to see Preferred Response
Figures A and B show radiographs on a minimally displaced humeral shaft fracture. The most appropriate treatment for this injury would be functional bracing (Sarmiento) for an additional 6-8 weeks or until healed. Commonly accepted parameters for closed treatment include less than 30 degrees of varus angulation, 20 degrees of anterior/posterior angulation, and 3 cm of shortening. Functional bracing has become the gold standard for humeral shaft fractures as it consistently shows excellent healing results as well as preventing the complication of shoulder +/- elbow stiffness associated with joint spanning splints or slings. Sarmiento et al. treated 922 patients with humeral diaphysis fractures with a prefabricated brace. They found a 97% rate of union with the use of the brace. In addition, only 2% of the patients had lost more than 25 degrees of shoulder motion at the time of brace removal. Koch et al. reviewed 67 humeral shaft fractures that were treated by Sarmiento bracing in a 15-year period. Fifty-eight cases (87%) had healed clinically at a mean of 10 weeks. Among 9 patients with delayed or nonunion leading to operative intervention, there were 6 cases with transverse fractures Figures A and B show a moderately displaced right humeral shaft fracture with 13 degrees of AP angulation, 10 degrees of varus/valgus angulation and no shortening, treated in a coaptation splint. A nondisplaced proximal humeral fracture is also seen. Illustration A shows an image taken of a patient wearing the sarmiento brace. Incorrect Answers: Answer 1,2: Joint spanning splints or slings have not shown to be superior to functional bracing. They are associated with joint stiffness post removal. Answer 4: Operative indications are: associated vascular injuries, bilateral humeral shaft fractures, polytrauma patient (including paraplegia), injury to the brachial plexus, pathological fractures, floating elbow, and floating shoulder. Answer 5: Staged operative procedure would be indicated in open fractures or significant deformity with soft-tissue swelling.
3.9
(7)
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