For a right humerus fracture, should we use a splint or an arm sling for immobilization?

Right Humerus Fracture Immobilization

For humerus fractures, use a posterior splint rather than just an arm sling, as splinting provides superior pain control and better functional outcomes compared to collar-and-cuff or sling-only immobilization. 1

Immobilization Strategy by Fracture Location

Proximal Humerus Fractures (Non-Displaced)

• Apply a posterior splint for initial immobilization for a minimum of 3 weeks, as this demonstrates better pain control compared to collar and cuff immobilization in prospective studies 1
• The posterior splint should be maintained continuously during the initial immobilization period 1
• Collar and cuff or sling-only immobilization provides inferior pain control and should be avoided as primary treatment 1

Humeral Shaft Fractures

• Functional bracing is the preferred method for shaft fractures, allowing greater elbow range of motion (11-126 degrees) compared to plaster U-slab immobilization (50-119 degrees) without affecting fracture healing or alignment 2
• Humeral fracture braces are easy to apply and adjust, with high patient acceptance 2
• Current evidence shows increasing nonunion rates with conservative treatment alone, suggesting surgical indications may need reconsideration for certain shaft fractures 3

Critical Monitoring Requirements

Radiographic Follow-Up

• Obtain repeat radiographs during the first 3 weeks of treatment to confirm the fracture remains non-displaced 1
• Repeat imaging at cessation of immobilization (around 3 weeks) before advancing rehabilitation 1
• Skipping radiographic follow-up risks missing progressive displacement that may require surgical intervention 1

Timing of Mobilization

• Immobilization typically lasts 1-3 weeks depending on fracture stability 4
• Begin functional exercises as soon as false motion can be excluded by careful examination 4
• Continue exercises longer than bone union time (expected at 6-8 weeks) to achieve optimal functional recovery 4

Pain Management Protocol

• Prescribe paracetamol on a regular basis unless contraindicated 1
• Use opioids cautiously, particularly in elderly patients with renal dysfunction 1
• Avoid NSAIDs in patients with renal impairment 1
• Consider nerve blocks (femoral or fascia iliaca) for additional pain control if needed 1

Common Pitfalls to Avoid

• Do not use collar and cuff or sling alone as primary immobilization for proximal humerus fractures, as it provides inadequate pain control 1
• Avoid prolonged immobilization beyond 3 weeks without clinical justification, as this increases risk of shoulder stiffness 5
• Do not delay early controlled stress through the fracture site, as immediate treatment optimizes bone repair without increasing complication rates 5
• Recognize that electrotherapy and hydrotherapy do not enhance recovery, and joint mobilization has limited evidence of efficacy 5

Special Considerations

Pediatric Fractures

• For non-displaced pediatric proximal humerus fractures, posterior splinting provides superior pain relief within the first 2 weeks compared to collar and cuff 6
• Obtain comparison radiographs of both shoulders with internal and external rotation views to assess physeal widening 6

Displaced Fractures

• Fractures are considered displaced if fragments are displaced >1 cm or angulation exceeds 45 degrees, requiring reduction 4
• Surgical management may be indicated for displaced fractures, though specific techniques depend on fracture pattern and patient factors 7