The results of functional (Sarmiento) bracing of humeral shaft fractures

At the Department of Orthopaedics of the Kantonsspital Fribourg, 67 humeral shaft fractures were treated by Sarmiento bracing in a 15-year period. There were 54 isolated fractures and 73 fractures sustained as a component of polytrauma. Fifty-eight cases (87%) hod healed clinically at a mean of 7 0 weeks; 9 cases failed to heal, so further treatment was carried out operatively. Of the conservatively managed fractures, 95% (55 cases) heated with an excellent or good result. Three patients noted a slight limitation of active range of motion, but all 58 patients returned to full duty at their jobs. Among 9 patients with delayed or nonunion leading to operative intervention, there were 6 cases with transverse fractures. Major reasons for failed conservative management were an incorrect indication, a significant axial deformity or a hyperextended position of the fracture fragments. In our experience, active repositioning of humeral shaft fractures is not effective in avoiding a delay in fracture healing. The decision to use functional bracing in polytrauma patients should depend on the time of expected bedridden immobilization, on the presence of additional fractures of the ipsilateral upper extremity and on the patient's need for crutches. The conservative treatment of humeral shaft fractures with the Sarmiento brace remains the treatment of choice, in spite of newer intramedullary operations that are allegedly minimally invasive and technically less complicated.