Treatment of Humeral Shaft Fractures with Immediate Sarmiento Bracing

Standard of care for closed humeral shaft fractures without iatrogenic radial nerve palsy involves placement into a coaptation splint or hanging arm cast followed by conversion into a functional brace at 7-14 days (1) . These transient splints or casts require time and skill to apply, limit hygiene for the patients, restrict range of motion at the elbow and shoulder, as well as are prone to skin complications. Retrospective data from a single study presented as an abstract suggests that immediate functional bracing after injury has equivocal functional outcomes and radiographic alignment, as well as superior patient satisfaction scores (2). At the time of writing, there is no published level one evidence to support this data. Given this, as well as the high rate of union and acceptable alignment obtained with conservative management of these fractures, we aim to conduct a prospective randomized controlled trial to investigate the outcomes for non-operative management of humeral shaft fractures treated with delayed versus immediate functional bracing. This study will evaluate whether immediate functional bracing will produce equivalent outcomes. The primary outcome variable will be Disabilities of Arm, Shoulder and Hand (DASH) scores at 3 months post injury. Secondary outcomes will be radiographic alignment in coronal and sagittal planes, failure of conservative management, and rates of complications. The null hypothesis is that there is no significant difference in functional outcomes (DASH score at 3 months) between immediate and delayed functional bracing.