SOPtitle Managementofhumeralshaftfracture

SOPnumber

Versionnumber V1

Effectivedate

Author DrMichaelaBlood,DrParamjitSinghInconjunctionwithMrNeilPennington

Approvaldate

Distribution AllseniormedicalstaffandENPs

Location CHFTEDcross-site

Inclusioncriteria–allclosedneurovascularly intactadulthumeralshaftfracturesexcludingintra-articular fractures of either the proximal or distal humerus, and surgical neck ofhumerus.CurrentmanagementinvolvesapplicationofPlasterofParisU-slabwhichisthenreplacedinfracture clinic approximately oneweek later to a humeral brace. This SOP is designed toimprovepatientsatisfactionandcomfort,andreducefollowuprequirementsbyapplyingahumeralbracewithintheEDonthefirstpresentation.If unsurewhether or not the fracture if appropriate for humeral bracemanagement, thepatientshouldbediscussedwiththeoncallOrthopaedicteam.Management

1) Identificationofhumeralfractureonradiographappropriateformanagementwithahumeralbrace

2) Ensureadequateanalgesiapre-applicationofbrace3) Application of brace as per instructions available (or can direct to plaster room in

hours)4) Repeatradiographtocheckpositionoffracture5) Discharge with patient advice and virtual fracture clinic appointment (unless

inappropriateforvirtualfractureclinic

Humeralbraceapplication

1)Openpacket–shouldcontainblackhumeralbraceandbluesling.Sizeisbasedonmidhumeralcircumferenceandbracelength,asperchartavailable.Thehypoallergenicfabriccasingholdstwoplasticshells–theinnershellshouldberemovedandtrimmedifconcernsofpressuretoinnerelbowBEFOREapplyingthebracetothepatient(eithermeasureortryoppositearm).

2)Lengthenthecheststrapaslongaspossibleanduncliptheclipthatwillbefastenedbehindthepatient.

3)CrocodileVelcrofastenersareontheendofeachstrap.Inordertostretchthebracetomakeiteasiertoapply,curlthecrocodilefastenerbackoneachadjustmentstrapandplaceyourhandsinthebracetostretchitout.

4)Thisbraceshouldbeplacedunderneathclothingsothatthepatientdoesnotattempttoremoveitathome.Encouragethepatienttodroptheaffectedarmdownbytheirsideandglidethebraceupthearm.Ifthereisalotofresistance,achangeinbracesizemayberequired.Bringthebraceupsothattheoutershelliscoveringtheshoulderandholdinplace.

5)Whilstholdingthebraceinposition,bringthecheststraparoundthebodyandcliptogetherensuringitisoverthechestandnotbeneathbreasttissue.Removeanyslackinthecheststrapbyusingthecrocodilefastener.Ifthecrocodilefastenerpositionendsupbeingintheaxillaryareawhereitmaycausefriction,removethecrocodilefastenercompletelyandtrimthecheststrapsothatthefastenerendsuponthebackratherthantheaxilla.

6)Usetheadjustmentstrapsonthebracetotightenthebrace,makingsurethatoppositestrapsandpulledatthesametimetomaintaintension.Bothupperandloweradjustmentstrapsmustbetightened.

7)Withthetowelledsideoftheslingtouchingthepatient’sback,attachtotheposterioraspectofthebraceandbringovertheoppositeshoulder.Bringtheelbowofthebracedarmto90degreesflexionandrestintheslingusingtheVelcrotoattachtheslingtoitself.Thewristmustberestinginthesling,nottheforearm,topreventwristdrop.