Functional Outcome In Conservative Management Of Diaphyseal Humerus Fractures - A Comparative Assessment On The Use Of U Slab Vis-À-Vis Functional Brace

Abstract

Background Diaphyseal humerus fractures constitute about 3% of the overall fracture incidence with an increasing incidence locally attributed to a rise in road traffic crashes, more so from boda boda related accidents. Overall a majority are conservatively managed with good outcomes. Several methods exist for conservative management of humerus shaft fractures including hanging casts, coaptation splints or u-slabs, velpeau bandages and functional braces. Several authors consider the use of functional brace as the gold standard due to easy applicability and allowance of greater shoulder and elbow motion. In our local setup, the humerus fractures are conservatively managed by the use of u-slab. This study made a comparative assessment of functional outcomes in terms of u slab vis a vis functional brace, with the aim of establishing whether there was a significant advantage of one method over the other and transferring the same benefits to the overall patient care. Study objective To evaluate and compare the early functional outcome in diaphyseal humerus fractures after treatment with either functional brace or u-slab. Study design Comparative prospective analytical study Study setting The study was conducted at the Kenyatta National Hospital (KNH), Accident and Emergency Department and clinic no 5, and Presbyterian Church of East Africa (P.C.E.A) Kikuyu Hospital, at the Orthopaedic rehabilitation unit. Materials and Methods A total of 68 study participants were recruited and followed within a period of 6 months. The participants were divided into two groups, group A for u-slab and group B for functional bracing. All the participants were initially managed as per the hospital protocol with a u-slab upon being seen x at A & E. Participants in group B were then be converted into a functional brace after one week. All the participants were then followed at 4,8 and 12 weeks. A radiograph was taken after application of u slab or functional brace and during follow-up visits to assess for alignment and bridging callus. At 12 weeks, the u-slab and functional brace were removed and functional assessment done using validated tools. Data was entered in password protected excel spread sheet tables and then analyzed using SPSS version 21.Descriptive summary statistics included means and standard deviation for continuous data and frequencies and proportions for categorical data. P values and 95% confidence intervals (CIs) were be calculated. A p value <0.05 was considered statistically significant, based on two sided t-tests. Results A total of 68 patients were followed for a duration of 12 weeks after which the early functional outcome was assessed. The mean age of patients was 35.7 years .The male to female ratio was approximately 2:1. Majority affected the right humerus. The middle 1/3 of the humerus was the commonly involved segment. Most of the fractures were AO classification 12A.There was a statistically significant difference in functional outcomes as assessed by ASES (p<0.001) and MEPI (p<0.014) scores between the patients managed on functional braces and those managed on braces with the functional brace showing superior results. Conclusions and Recommendations Majority of humerus shaft fractures are managed conservatively. Functional braces have a superior early functional outcome in conservative management of humerus shaft fractures as demonstrated in this study. It is recommended that where cost allows, patients should be given the benefit of use of functional braces to allow an early return of good shoulder and elbow range of motion. Further studies with larger sample sizes and longer duration of follow up are required to assess the long term outcomes in terms of union with the use of the two methods.