Cutaneous Complications of Functional Bracing of the Humerus

Abstract

Patient selection is important when functional bracing is chosen for the treatment of diaphyseal fractures of the humerus. When functional bracing is properly applied to well-selected patients, nonunion rates are low, and skin complications are almost nonexistent. We describe a patient with a closed diaphyseal humeral fracture who experienced skin breakdown and ulceration from the brace with protrusion of the proximal fracture spike, effectively converting a closed fracture into an open one. The patient and her primary caregiver (her daughter) were informed that data concerning the case would be submitted for publication, and they consented. An eighty-seven-year-old woman fell from standing height and landed on the right (dominant) arm. On examination in the emergency department, a varus deformity of the right humerus was evident and radial nerve function was intact. There was some minor bruising over the anterolateral aspect of the arm, corresponding to irritation from the tip of the proximal fragment, but there was no open wound. Radiographs revealed a long spiral AO-OTA 12-A1 diaphyseal fracture extending from the proximal third to the middle of the shaft of the humerus (Fig. 1). The proximal fragment was widely abducted and was pointing laterally. Initial treatment was accomplished by placing the arm in a hanging U-shaped plaster coaptation splint, and the patient was advised against abducting the right arm. Because the fall had not been witnessed, the patient was admitted for additional neurological evaluation. Fig. 1 Radiographs showing the AO-OTA 12-A1 fracture of the right humerus. As the patient had multiple underlying comorbidities, including atrial fibrillation, coronary artery disease, mitral valve prolapse with regurgitation, bronchial asthma, and Alzheimer dementia, a nonoperative course of treatment was chosen. On the second day of admission, a thermoplastic brace was fabricated and applied (Fig. 2). The brace had two components—an anterior shell and a posterior interlocking shell, …