The Outcome of Conservative Treatment of Closed Fracture Shaft Humerus in Adult Patients

Abstract

Problem statement: Fractures of the humeral shaft are commonly encountered by the orthopaedic surgeons; accounting for approximately 3% of all fractures. There is a wide array of good options for their treatment and controversy over th e best methods for many situations. Appropriate nonoperative and operative treatment of patients wi th humeral shaft fractures, however, requires an understanding of humeral anatomy, the fracture patt ern and the patient's activity level and expectations. Although good techniques of osteosynt hesis are available, the aim of this article is to emphasize on the benefit and good outcome of conservative treatment for properly selected cases to decrease the cost and avoid the complications of su rgery. Approach: During the period from Jan 2008 to Jun. 2009 seventy-eight fractures of humeral sha ft were treated at Orthopaedic Department in the Tikrit Teaching hospital. 20 fractures considered s uitable for the study. The patients treated conservatively by using the'U' shaped coaptation sl ab and the patients evaluated both clinically and radiologically every two weeks. If there is much pa in or any degree of malalignment, we shift to POP cast. Then we follow the patient clinically and rad iologically every 2-4 weeks and until the fracture had united and the limb functions were restored. Th e outcome of treatment was assessed by specific parameters which include alignment, rate of union a nd limb functions. Results: This study showed that the initial deformities of angulation were consider ably reduced by the use of U slab and the POP cast which act as a dynamic rather than a static splint, correcting angulation to less than 30° in coronal plane and less than 20° in sagital plane. Manipulat ion of the fracture was not required and did affect neither the rate of union nor the final position, a s the cast appeared to be capable of correcting angulation deformities. Perfect anatomical reductio n was found not to be essential for satisfactory li mb function, which was present with virus angulation a nd posterior bowing. The incidence of delayed union compares favorably with other reported series , although the definition of delayed union is variable. Conclusion: In fracture shaft of humerus, neither rigid immobi lization nor perfect alignment are of great importance for final outcome, so conse rvative treatment is one of the most effective methods of treatment and the operative treatment ca n lead to adverse effect on the outcome in case of bad judgment and should be limited as much as possible to specific indications.