Functional and Radiological Outcomes of Conservative Treatment of Upper Limb Diaphyseal and Metaphyseal Fractures (Humerus, Radius, and Ulna) with Extension Casting

Abstract

To manage fractures, either operative or nonoperative techniques are required. If the fracture is significantly displaced or angulated, a closed reduction should be done followed by a period of immobilization with casting or splinting. This treatment method forms the basis of nonoperative approach. To evaluate the results of management of upper limb diaphysis and metaphyseal fractures (humerus, radius, and ulna) with the application of extension cast in closed fractures in adults to assess the functional acceptance of the procedure and to assess the efficacy and advantage of this treatment. The study included upper arm fracture patients. Fixed criterion was discouraged for a definite sample size and it was considered to take up as many cases as possible from trauma center on every Wednesday in the entire period of data collection, i.e., from September 2020 to May 2022. Forty-two newly diagnosed cases of the fracture of upper extremities whose radiological and clinical records were intact were included in the study. Patients in the extension casting group were followed up from 14 to 22 months, with an average of 17.34 ± 2.61 months. The full-length cast was applied from 4 to 6 weeks with a mean of 5 weeks. All casts were converted to the above elbow cast when the fracture became sticky. Radiological evidence of a fluffy callus appeared at an average of 35 days and bony union was achieved at a mean of 3.48 ± 0.59 months. In the current study after 1 year of treatment, the mean range of motion of all joints of the affected limb became normal; the mean Visual Analog Scale (VAS) score after 6 weeks was 8; after 3 months, the mean VAS score was 4; and after 6 months, the mean VAS score was 1. Extension cast allows gravity to work all the time, which is especially beneficial for comminuted fractures. This reduces the chances of limb shortening.