Conservative treatment of the uncomplicated Holstein Lewis humeral shaft fracture

Conservative treatment of the Holstein Lewis humeral shaft fractures remains a very attractive option because there is no risk of iatrogenic radial nerve injury or infection. In addition, the multi-fragmented subgroup of those rare fractures run the risk of non union after operative treatment as there is soft tissue dissection during surgery which disrupts the blood flow to the fracture fragments.

If after application of a Sarmiento brace the fracture shortening is less than 1 cm and the angulation on the AP and lateral plane less than 30 degrees then conservative treatment should be considered.

A case example is shown below that ended up in satisfactory outcome and healing in acceptable position.

Injury film

After application of the Sarmiento brace, AP view

After application of the Sarmiento brace, LAT view

3 months after the fracture is healed

3 months after the fracture is healed

A similar case is illustrated below.

Injury film

Sarmiento application

70 days after the injury the fracture is healed with no angulation of the lateral view

70 days after the injury the fracture is healed with 17 degrees of angulation on the AP view which is within the acceptable limits of malunion

The patient has no function deficits in the ROM of the elbow and is pain free.