Sarmiento's 1977 landmark case series tested whether a plastic functional sleeve — applied within the first week of injury — could heal humeral shaft fractures without rigid immobilization. The study enrolled 51 fractures and asked whether early joint motion and controlled interfragmentary motion were compatible with reliable union.
Before this paper, humeral shaft fractures were managed with prolonged immobilization — hanging casts, sugar-tong splints, Velpeau bandages. All of which restricted joint motion and required extended rehabilitation to recover function.
When you see a closed humeral shaft fracture in a healthy patient, apply a functional brace within the first week and start range-of-motion exercises immediately. This paper is why we do not immobilize the shoulder and elbow while the humerus heals.
When you see radial nerve palsy at presentation, observe. Every palsy in this series resolved without surgical intervention. Exploration is not indicated for nerve injury associated with the acute fracture.
Pathological fractures are the critical exception. The one nonunion in this series occurred in a patient on chemotherapy for metastatic breast carcinoma. When bone quality or biology is compromised, functional bracing alone is insufficient and internal fixation should be considered.
Sarmiento's 1977 landmark case series tested whether a plastic functional sleeve — applied within the first week of injury — could heal humeral shaft fractures without rigid immobilization. The study enrolled 51 fractures and asked whether early joint motion and controlled interfragmentary motion were compatible with reliable union.
Before this paper, humeral shaft fractures were managed with prolonged immobilization — hanging casts, sugar-tong splints, Velpeau bandages. All of which restricted joint motion and required extended rehabilitation to recover function.
When you see a closed humeral shaft fracture in a healthy patient, apply a functional brace within the first week and start range-of-motion exercises immediately. This paper is why we do not immobilize the shoulder and elbow while the humerus heals.
When you see radial nerve palsy at presentation, observe. Every palsy in this series resolved without surgical intervention. Exploration is not indicated for nerve injury associated with the acute fracture.
Pathological fractures are the critical exception. The one nonunion in this series occurred in a patient on chemotherapy for metastatic breast carcinoma. When bone quality or biology is compromised, functional bracing alone is insufficient and internal fixation should be considered.