Functional Scarcing

933 Words4 Pages
Sarmiento et al, have published a relatively large study of 620 patients with 97 % union rates and high satisfaction rates with functional bracing. He clearly demonstrated the benefits of treatment with functional bracing as it has acceptable outcomes with little morbidity. These outstanding results have not been proven by any other studies, which is why there is significant controversy regarding optimal management. There is significant argument regarding what specific type of humeral shaft fractures are best treated with a fracture brace. Rutgers and Ring retrospectively reviewed treatment of diaphyseal humerus fractures that were treated with functional bracing and found that proximal humeral shaft fracture with oblique pattern are at greater…show more content…
Of all fractures that were treated with functional bracing, 72 consolidated without any problems. Residual mal-alignment did not exceed 20 degree in any plane in any of the fractures. Six patients experienced a temporary radial nerve palsy diagnosed before fracture reduction with bracing. In 21 fractures, brace treatment failed, and fractures were surgically treated using plating in (11 patients), with intramedullary nailing (6 patients) or intramedullary nailing in combination with wires in (4patients). 6 fractures out of 13 in the proximal third, 48 out of 59 in the middle third and 18 out of 21 in the distal third united using a functional brace. There was a significant difference noted that over half of the fractures of the proximal third of the humerus in their study treated with functional bracing went on to nonunion as compared to distal segment of…show more content…
In the plate fixation cohort of 19 patients, they found that all patients regained shoulder motion within 10 degrees of normal, and the average loss of elbow motion was 3 degrees. There were no nonunions and complications included one infection, one distal fixation screw loosening due to osteopenia, and 3 patients with new onset radial nerve palsies post operatively. Of the 21 patients in the nonoperative cohort, two patients ended up with surgery and plate fixation, both for malalignment. The rest of the patients treated nonoperatively went on to heal, although six healed with 11–20 degrees of malalignment and three healed with greater that 20 degrees of malalignment. Therefore, operative treatment achieves more predictable alignment and potentially quicker return of function but risks iatrogenic nerve injury and infection and the need for reoperation. Functional bracing can be associated with skin problems and varying degrees of angular deformity, but function and range of motion are usually
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