How long does a humerus fracture immobilized in a Sarmiento (surgical arm brace) typically require immobilization?

Duration of Immobilization for Humerus Fractures in a Sarmiento Brace

Humerus fractures immobilized in a Sarmiento brace typically require 10-12 weeks of treatment, with an average healing time of 10 weeks. 1

Treatment Timeline

The immobilization period for humerus fractures in a Sarmiento brace follows a general timeline:

1. Initial Phase (0-2 weeks):

   • Often preceded by a short period of immobilization with a cast or splint
   • Initial immobilization with sling and pendulum exercises 2

2. Early Mobilization Phase (2-6 weeks):

   • Transition to Sarmiento brace
   • Progressive active-assisted range of motion exercises 2
   • Regular radiographic evaluation at 1,3, and 6 weeks to ensure fracture stability 2

3. Strengthening Phase (6-12 weeks):

   • Progressive resistive exercises
   • Scapular stabilization exercises 2
   • Continued bracing until clinical and radiographic healing

Evidence for Immobilization Duration

Research shows that functional bracing with a Sarmiento brace leads to clinical healing at a mean of 10 weeks for most patients (87% of cases) 1. This is supported by multiple studies showing good outcomes with this timeframe:

• In a 15-year study of 67 humeral shaft fractures, 87% healed clinically at a mean of 10 weeks using Sarmiento bracing 1
• Functional bracing permits greater functional use of the limb without affecting fracture healing and alignment 3
• A large study of 620 patients showed high union rates with functional bracing, particularly for closed fractures 4

Advantages of Functional Bracing

Functional bracing offers several advantages over rigid immobilization:

• Better functional outcomes compared to immobilization 5
• Greater range of elbow motion during healing process 3
• Allows progressive use of the injured extremity 4
• High patient acceptance of this treatment method 3

Monitoring During Treatment

Regular follow-up is essential during the bracing period:

• Radiographic evaluation at 1,3, and 6 weeks to ensure fracture stability 2
• Clinical assessment of pain and range of motion at each follow-up 2
• Adjustments to the brace as needed to maintain proper alignment

Potential Complications and Considerations

While functional bracing is generally effective, be aware of potential issues:

• Transverse fractures have higher rates of delayed union or nonunion 1
• Incorrect indication, significant axial deformity, or hyperextended position of fracture fragments may lead to treatment failure 1
• Some studies show ORIF may result in faster union time (approximately 4.8 weeks shorter) compared to functional bracing 6

Special Considerations for Polytrauma Patients

For polytrauma patients, the decision to use functional bracing should consider:

• Expected duration of bedridden immobilization
• Presence of additional fractures in the ipsilateral upper extremity
• Patient's need for crutches 1

Most humerus fractures can be treated non-operatively with good functional outcomes, as noted in guidelines for proximal humeral fractures 5. The Sarmiento brace remains the treatment of choice for appropriate fractures despite newer surgical techniques 1.