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

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 the best methods for many situations. Appropriate nonoperative and operative treatment of patients with humeral shaft fractures, however, requires an understanding of humeral anatomy, the fracture pattern and the patient’s activity level and expectations. Although good techniques of osteosynthesis 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 surgery. Approach: During the period from Jan 2008 to Jun. 2009 seventy-eight fractures of humeral shaft were treated at Orthopaedic Department in the Tikrit Teaching hospital. 20 fractures considered suitable for the study. The patients treated conservatively by using the‘U’ shaped coaptation slab and the patients evaluated both clinically and radiologically every two weeks. If there is much pain or any degree of malalignment, we shift to POP cast. Then we follow the patient clinically and radiologically every 2-4 weeks and until the fracture had united and the limb functions were restored. The outcome of treatment was assessed by specific parameters which include alignment, rate of union and limb functions. Results: This study showed that the initial deformities of angulation were considerably 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. Manipulation of the fracture was not required and did affect neither the rate of union nor the final position, as the cast appeared to be capable of correcting angulation deformities. Perfect anatomical reduction was found not to be essential for satisfactory limb function, which was present with virus angulation and 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 immobilization nor perfect alignment are of great importance for final outcome, so conservative treatment is one of the most effective methods of treatment and the operative treatment can lead to adverse effect on the outcome in case of bad judgment and should be limited as much as possible to specific indications.