[Functional therapy of diaphyseal fractures of the humeral bone]

T Gongol, D Mrácek
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2002, 69 (4): 248-53

PURPOSE OF THE STUDY: The authors present a method of the functional treatment of fractures of the humeral shaft at their department. They document its results on a group of 32 patients.

MATERIAL: The described method was used between 1992 and 2000 in 36 patients. Evaluation covered 32 patients. The minimal interval between the end of the treatment and evaluation of the group of patients was 1 year. Treated were closed fractures of the medial and distal thirds of the shaft. The average age of patients at the time of injury was 47 years (range, 18-87 years).

METHOD: The method described by the authors is based on the principles of the functional treatment of fractures advocated by Sarmiento. After indicating the patient for this therapy, a classic "rigid" fixation is assembled in the phase I. After obtaining elastic stability, it is replaced in phase II by a sleeve allowing full flexion of the elbow and minimally limiting the range of motion in the shoulder. As soon as mechanical stability develops (signs of callus on radiograph), the treatment enters its phase II which is characterised by a sleeve not limiting the motion of joints at all. The treatment ends upon the presence of a bone callus and absence of pain at the fracture site. During the whole therapy the skin condition is monitored and emphasis is put on the prevention of Sudeck's algoneurodystrophy. The authors evaluate the result of the treatment with a focus on the limitation of the range of motion of joints and the developing angulation of the humeral shaft.

RESULTS: The method of the functional treatment resulted in the healing of 97% of patients. Only in one case there developed a non-union requiring surgery. Hospitalized were 22% of patients, the average duration of hospitalization was 9.3 days (except for the patient with the nonunion). The total duration of fixation was 97 days (interval of 58 to 183 days). Limitation of the range of motion of the glenohumeral joint was found out in 47%, of the elbow in 28% of cases. However, the limitation itself exceeded only in 1 case 25 degrees. The resulting angulation of the axis of the limb with unlimited range of motion of the joint limits subjectively 1 patient.

DISCUSSION: The authors attempt to address in their work the permanent conflict between the concepts of the surgical and conservative therapy. They themselves prefer the method of functional treatment at their department. They fully support the fact that the function is necessary for both healing and prevention of the subsequent limitation of the range of motion. For the sake of the function, in harmony with others they waive the requirement for an accurate anatomical reduction of fragments. The results they present prove a high percentage of healing without complications. The resulting angulation of the humeral shaft limits the patients neither from the functional nor cosmetic viewpoints. Subjective evaluation of the course of the treatment by patients was mostly positive. A prerequisite of the success of the method is also selection of patients from which it is possible to expect cooperation with the physician throughout the whole treatment.

CONCLUSION: The results of the evaluated group of patients managed by the method of the functional treatment entitle the authors to state that this procedure is the method of choice in the therapy of closed fractures of the distal two thirds of the humeral shaft not associated with neural or vascular lesion, although the exact mechanism promoting the process of osteogenesis in the course of the treatment is not quite known. The benefit of this method is that patients may be almost exclusively treated in the out-patient department and that there is a minimal incidence of complications. However, it is a time-intensive procedure both for the physician and the patient.

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