Rıdvan Oğuz Kara

Gölbaşı State Hospital, Department of Orthopedics and Traumatology, Adıyaman, Türkiye

Kara RO. Conservative Management of Humeral Diaphyseal Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1^st ed. Ankara: Türkiye Klinikleri; 2025. p.91-95.

ABSTRACT

Humerus fractures account for approximately 5% to 8% of all extremity fractures. When deciding on conservative management for humeral diaphyseal fractures, we must first pay attention to patient selection. The type and location of fracture, the patient’s additional diseases, obesity, and whether there is a neurovascular injury should be considered. When deciding on conservative management for smokers and non-compliant patients, we must think carefully, inform the patient well about process, and plan the management process well. We must know the characteristics of Holstein-Lewis fractures. We must pay attention to radial nerve damage, and it should not be forgotten that radial nerve damage is not an absolute contraindication for conservative management. If there is radial nerve damage after reduction, surgical nerve exploration may be required. Conservative management criteria for humeral diaphyseal fractures are broader due to the greater mobility of the shoulder joint; <3 cm shortness, <30° varus/ valgus angulation, <20° anterior angulation. We must meticulously perform and note neurovascular examination before and after reduction. Nerves where neuropraxia may occur are radial nerve, ulnar nerve and axillary nerve. After reduction, fixation methods such as coaptation splint or hanging arm cast can be used. After fracture alignment is achieved (approximately 7-10 days), Sarmiento brace, which is the most used fixation method today, is used. In addition to fracture healing, the Sarmiento brace preserves joint range of motion thanks to the freedom it provides to the shoulder and elbow joints. In many studies in the literature, it has been found that Sarmiento brace has been used successfully in humeral diaphyseal fractures. The duration of conservative management for humeral diaphyseal fractures varies between 8 and 14 weeks, with an average of 10.4 weeks. Nonunion, malunion, and decreased range of motion are complications. If we think that conservative management will fail, we should be able to make the surgical decision at the right time. In order to maintain shoulder and elbow joint range of motion, we must manage the rehabilitation process well and avoid unnecessary immobilization. Conservative management currently maintains its place as the gold standard treatment method for humeral diaphyseal fractures.

Keywords: Humerus diaphyseal fractures; Conservative treatment; Sarmiento brace; Coaptation splints; Holstein-Lewis fracture; Humeral fractures