Set it and Forget it: Diaphyseal Fractures of the Humerus Undergo Minimal Change in Angulation After Functional Brace Application.

Objectives: To quantify radiographic changes observed in humeral shaft frctures throughout course of treatment with functional bracing.

Design: Retrospective cohort study.

Setting: Level 1 Trauma Center and affiliated Tertiary Care Center.

Patients: 72 retrospectively identified patients with fracture of the humeral diaphysis.

Intervention: Application of functional brace with radiographs obtained immediately after brace application and at 1 week, 2 weeks, 3 weeks, 6 weeks, 3 months, 6 months and 12 month follow-up.Main Outcome Measure: Fracture angulation, measured in the coronal and sagittal planes.

Results: 522 radiographs from 72 patients were critically reviewed. All fractures were followed to healing. Sixty-six patients (92%) successfully healed their fractures with non-operative treatment. The average angulation on immediate post-brace X-ray was 12 degrees varus ad 7 degrees procurvatum. At final follow-up, average coronal angulation was 14 degrees and 4 degrees procurvatum. Fracture angulation changed a mean 2 degrees in the AP plane and 3 degrees in the sagittal plane over the course of care. Linear regression determined fracture angulation proceeds toward both varus and recurvatum at 0.01 degrees per day.

Conclusion: Humeral shaft fractures treated non-operatively heal with minimal change in angulation after brace application. If angulation on the post-brace radiograph is acceptable and there is no history of repeat trauma and no cosmetic deformity, radiographs may be utilized less frequently. Patients should be evaluated via history and physical exam at follow-up prior to the 6-week point, at which time regular radiographs (6 week, 3 month, 6 month, 12 month) should commence.