The results of functional (Sarmiento) bracing of humeral
shaft fractures
Peter P. Koch, MD,a Dominique F. L. Gross, MD,b and Christian Gerber, MD,a Zürich, Switzerland
At the Department of Orthopaedics of the Kantonsspi-
tal Fribourg, 67 humeral shaft fractures were treated
by Sarmiento bracing in a 15-year period. There were
54 isolated fractures and 13 fractures sustained as a
component of polytrauma. Fifty-eight cases (87%) had
healed clinically at a mean of 10 weeks; 9 cases
failed to heal, so further treatment was carried out op-
eratively. Of the conservatively managed fractures,
95% (55 cases) healed with an excellent or good re-
sult. Three patients noted a slight limitation of active
range of motion, but all 58 patients returned to full
duty at their jobs. Among 9 patients with delayed or
nonunion leading to operative intervention, there were
6 cases with transverse fractures. Major reasons for
failed conservative management were an incorrect in-
dication, a significant axial deformity, or a hyperex-
tended position of the fracture fragments. In our expe-
rience, active repositioning of humeral shaft fractures
is not effective in avoiding a delay in fracture healing.
The decision to use functional bracing in polytrauma
patients should depend on the time of expected bed-
ridden immobilization, on the presence of additional
fractures of the ipsilateral upper extremity, and on the
patient’s need for crutches. The conservative treatment
of humeral shaft fractures with the Sarmiento brace
remains the treatment of choice, in spite of newer in-
tramedullary operations that are allegedly minimally
invasive and technically less complicated. (J Shoulder
Elbow Surg 2002;11:143-150.)
INTRODUCTION
In 1964 Böhler3 stated that fractures of the hu-
meral shaft are the most benign of all diaphyseal
fractures of long bones and are almost invariably
From the Department of Orthopaedicsa and the Division of Anes-
thesiology,b University of Zürich and Kantonsspital Fribourg,
Switzerland.
Reprint requests: Christian Gerber, MD, Department of Orthopae-
dics, University of Zürich, Balgrist, Forchstrasse 340, CH– 8008
Zürich, Switzerland.
Copyright © 2002 by Journal of Shoulder and Elbow Surgery
Board of Trustees.
1058-2746/2002/$35.00 ⫹ 0 32/1/121634
doi:10.1067/mse.2002.121634
amenable to conservative treatment. In 1977 Sar-
miento et al22 described functional conservative
treatment of humeral shaft fractures with a brace
that allowed early activity of the affected extremity.
They reported excellent results in 51 fractures,
which had been immobilized for a mean of 11 days
to allow decrease of swelling and were then treated
in a functional brace until clinical healing, which
was observed at a mean of an additional 7 weeks.
Only 9 patients had a mild functional deficit; the
others recovered fully. Since then, functional brac-
ing has become the gold standard for the treatment
of humeral shaft fractures. Many studies* have
been published reporting results of functional brac-
ing in polytrauma patients,6,10,13,14,18,24,29,30 in
pathological fractures,12,18,20,24 in open frac-
tures,14,26,30 in fractures with associated primary
radial nerve palsy,6,13,18,24,26,29,30 in fractures
with associated incomplete plexus palsy,29 and
even in fractures with vascular injury.24 The litera-
ture suggests that there are only rare and relative
contraindications for functional bracing. Radial
nerve palsy† has been considered to be an indica-
tion for primary operative treatment by some, and
several authors prefer surgical treatment for oblique
fractures.6,16,27 Treatment remains controversial. It
was the purpose of this retrospective study to ana-
lyze the results of functionally treated humeral shaft
fractures in a time period in which operative treat-
ment of humeral shaft fractures is being recom-
mended more and more aggressively because al-
legedly more biological or less invasive procedures
such as intramedullary nailing have become available.
MATERIALS AND METHODS
Ninety-one humeral shaft fractures were treated in 90
patients in our institution in a 15-year period. Seventeen
fractures were operated on acutely on the basis of an
individual decision of the attending physician on call. Sev-
enty-four fractures were treated with functional bracing. Six
of these patients were initially treated at our institution but
subsequently lost to follow-up. One patient died after the
beginning of the treatment; thus 67 braced fractures re-
mained for analysis.
*References 4, 10, 14, 16, 18, 20, 23, 26, 28, 30.
†References 2, 6, 9, 10, 12, 13, 18, 20, 22, 23, 26, 30.
143
144 Koch et al
Figure 1 Evaluation of fracture types according to AO/ASIF classification15 (n ⫽ 54).
Figure 2 Patient with properly fitted Sarmiento brace. On a plaster
model of the patient’s arm, the brace is adapted, consisting of a
dorsal and ventral part. With the help of a Velcro strap system, it
can be tightened.
J Shoulder Elbow Surg
March/April 2002
The 67 braced cases consisted of 54 patients with a
monotrauma and 13 patients who had incurred their hu-
meral shaft fracture as 1 element of a polytrauma. The 54
fractures in the monotrauma group occurred in 35 male
patients and 19 female patients with a mean age of 39
years (range, 11-83 years). The right arm was affected 25
times, the left 29. The proximal third of the diaphysis was
fractured in 16 patients, the middle third in 28, and the
distal third in 10. According to the AO/ASIF classifica-
tion,15 there were 32 simple fractures (type A), 14 wedge
fractures (type B), and 8 complex fractures (type C) (Figure
1). Most injuries occurred during a fall (30 cases, 55.6%)
or as a result of a bicycle or motorcycle accident (20 cases,
37%). Four fractures (7.4%) were sports injuries. Of 54
fractures, 51 were closed, 1 was grade 1 open, 1 was
grade 2 open, and 1 was grade 3 open.7,8 Primary radial
nerve palsy was diagnosed in 4 patients (7.4%), 2 being
complete and 2 incomplete.
Thirteen fractures were treated in 13 polytrauma pa-
tients. Their mean age was 23.1 years. The middle third of
the diaphysis was fractured in 9 patients, the distal third in
3, and the proximal third in 1. There were 8 type A, 3 type
B, and 1 type C fracture. One patient had an open fracture,
and 1 had a fracture associated with a plexus palsy.
Conservative treatment was divided into 3 phases: im-
mobilization, functional bracing, and rehabilitation. Ini-
tially, the fracture was immobilized with different methods
such as hanging cast, dorsal splint, Desault bandage, or
extension. Active manipulative reduction was not per-
formed because of the risk of additional radial nerve palsy.
Mobilization of the shoulder was started as soon as possi-
ble. After subsidence of swelling, a brace was applied
(Figure 2). Outpatient physiotherapy with functional mobi-
lization of the shoulder and elbow followed. After clinical
consolidation of the fracture, the brace was removed and
the last phase begun. Physiotherapy was continued until a
good functional result was achieved. The final evaluation
took place 1 year after injury with clinical and radiographic
examination.
Each case was analyzed on the basis of the chart and
the radiographs, as well as the time to clinical and radio-
J Shoulder Elbow Surg Koch et al 145
Volume 11, Number 2

Table I Time (in weeks) to clinical consolidation of all isolated fractures that healed with functional bracing (treated: n ⫽ 54; healed and
analyzed: n ⫽ 48)

n Median Mean SD Range

Total cases 48 8.0 9.96 5.0 5-36

Diaphysial port
Proximal 14 9.5 10.3 3.8 6-18
Middle 25 8.0 10.2 6.1 5-36
Distal 9 8.0 8.8 3.4 5-15
Frequent fracture types
A1 12 7.5 8.1 2.1 6-12
A3 13 8.0 9.7 3.4 6-16
B1 8 9.0 10.4 3.5 6-15
Fracture type groups
A: Simple fractures 29 8.0* 8.8 3.0 5-16
B: Wedge fractures 13 10.0 12.1 7.9 5-36
C: Complex fractures 6 10.0 11.0 4.2 7-18
B and C 19 10.0* 11.7 6.8 5-36
Age
⬍40 y 27 9.0 10.0 6.0 5-36
ⱖ40 y 21 8.0 9.9 3.6 6-18

*P ⬍ .01 (Mann-Whitney U test).

logic consolidation, the degree of axial deformity, and the
functional outcome. Clinical consolidation was considered
present when there was no local tenderness, no fracture
mobility, and no pain at the fracture site upon use of the
arm. Radiologic consolidation was defined as the point in
time when solid callus circumferentially encased the fracture
site so that the former fracture line was no longer visible.
The clinical results were categorized as follows:
1. Excellent: normal, symmetric range of motion of shoul-
der and elbow; no pain.
2. Good: minor measurable limitation of range of motion
without functional deficit; no or minimal occasional
pain.
3. Unsatisfactory: limitation of range of motion with limita-
tion of limb function and/or intermittent or permanent
mild pain.
4. Poor: change of occupation because of functional defi-
cit; temporary or continuous disability.
RESULTS
Fracture consolidation was achieved in 48 of the
54 patients (88.9%) in the monotrauma group. The
mean time to clinical consolidation was 9.9 weeks
(range, 5 to 36 weeks). One union occurred after a
delay of 36 weeks in a type B2 fracture of the middle
third of the shaft. Treatment was complicated by a
secondary radial nerve palsy, pain, and difficulties in
the mobilization of the adjacent joints. A residual
flexion deficit of the elbow of 40° was noted with
axial deformity in the sagittal and frontal planes of
18° and 16°, respectively. The patient reported only
a slight handicap in overhead activities but was able
to continue his work without restriction and refused
any surgical correction.
Type A fractures required significantly (P ⬍ .01)
less time to clinical consolidation (n ⫽ 29; mean, 8.8
weeks) than type B and C fractures (n ⫽ 19; mean,
11.7 weeks). The mean time to radiographic consol-
idation was not dependent on the diaphyseal part of
the fracture nor on the fracture type (Tables I and II).
For frontal malalignment, a varus deformity be-
tween 6° and 10° was quite frequent (Figure 3).
Valgus deformity was very rare. Malalignment in the
sagittal plane was less frequent and nearly equal
(Figure 4). Twelve patients had no measurable defor-
mity, 16 had deformity in both planes between 1°
and 10°, and 20 patients had deformity of more than
10°. Deformity of more than 10° tended to be more
frequent in proximal fractures and was significantly
more frequent in complex fractures (type B and C vs
type A: P ⬍ .001; Table III). Range of motion of the
shoulder was symmetrical and normal in 28 cases
(58.3%). Range of motion of the elbow was symmet-
rical in 42 cases (87.5%). Patients older than 40
years were at a greater risk to have joint motion loss
develop compared with patients younger than 40
years. The most commonly restricted motion was ex-
ternal rotation (Table IV). Three primary radial nerve
palsies occurred with middle third fractures, and 1
after a proximal third fracture. All primary radial
nerve palsies recovered without any motor or sensory
deficit. No surgical exploration was performed.
Patients complained about rest pain during a mean
time of 4.1 weeks (median, 2.0 weeks; SD, 4.3
weeks), with a range between 1 and 20 weeks.
Noticeable pain with use was felt during a mean
period of 11.8 weeks (median, 9.5 weeks; SD, 7.7
weeks) with a range from 4 to 32 weeks. Ten patients
continued to have minor chronic pain.
146 Koch et al J Shoulder Elbow Surg
March/April 2002

Figure 3 Mean deformity in the frontal plane, n ⫽ 48 (mean, 60°; median, 5.5°; SD, 6.0).

Table II Time (in weeks) to radiologic consolidation of all isolated fractures that healed with functional bracing (treated: n ⫽ 54; healed and
analyzed: n ⫽ 48)

n Median Mean SD Range

Total cases 48 21.5 25.4 12.9 10-72

Diaphysial part
Proximal 14 20.5 24.3 10.3 14-52
Middle 25 23 26.4 11.9 13-56
Distal 9 19 24.9 19.2 10-72
Frequent fracture types
A1 12 19 23.3 12.4 10-52
A3 13 25 28.6 13.4 13-56
B1 8 20.5 29.6 20.4 15-72
Fracture type groups
A: Simple fractures 29 23 25.3 12.1 10-56
B: Wedge fractures 13 21 27.7 16.8 10-72
C: Complex fractures 6 21 27.7 16.8 10-72
Age
⬍40 27 23.5 27.1 15.6 10-72
ⱖ40 21 21 23.3 8.0 14-52

Inability to work depended on the occupation. The
mean time off from work was 11.3 weeks (median,
10 weeks; SD, 7.32 weeks) with a range of 0 to 32
weeks. Six patients (white collar workers) were
treated on an outpatient basis and could resume their
occupations during the immobilization period.
Apart from failure of conservative treatment, the
following minor complications were noted: 2 second-
ary radial nerve palsies that recovered fully (3.7%, n
⫽ 54), 8 cases with prolonged swelling of the fore-
arm due to braces that were too tight, 5 cases with
noticeable crepitus at the fracture site during physio-
therapeutic mobilization, and 1 case in which the
patient was diagnosed with dermatitis under the
brace.
One patient sustained a refracture in a fall 6 weeks
after injury; bracing was continued for a further 8
weeks.
Finally, 46 cases (95.8%) were rated excellent or
good (50% excellent and 45.8% good), 2 (4.2%)
were unsatisfactory, and none was poor (Table V).
Polytrauma group
Fracture consolidation was achieved in 10 of the
13 cases (76.9%). The mean time to clinical consoli-
dation was 10.6 weeks, and to radiologic consolida-
tion 33.3 weeks. Because of the small number of
cases, consolidation time could not be related to
fracture type. For 8 patients (80%) a radiographic
J Shoulder Elbow Surg Koch et al 147
Volume 11, Number 2

Figure 4 Mean deformity in the sagittal plane, n ⫽ 48 (mean, 4.1°; median, 2.0°; SD, 8.2).

deformity of the humeral shaft, in either the frontal, Table III All cases with a minimum deformity in the frontal or
sagittal, or both planes, was more than 10°. Eight sagittal plane of more than 10° (n ⫽ 20)
patients (80%) had a symmetrical range of motion, Cases
and 2 (20%) complained of measurable limitation of (No.) %
mobility. Eight patients presented symmetrical func-
tion at the elbow, and 2 patients had a measurable Deformity ⬎10° 20 41.7%
Diaphysial part
limitation of mobility. On the basis of our grading Proximal 7/14 50%
system, 6 cases (60%) were excellent, 3 (30%) good, Middle 11/25 44%
and 1 (10%) unsatisfactory (Table V). Varus deformity Distal 2/9 22.2%
was observed most frequently but was subjectively Frequent fracture types
irrelevant for all patients. Functionally, an excellent A1 3/12 25%
outcome was confirmed in this study, as was a poten- A3 2/13 15.4%
B1 6/8 75%
tially limiting loss of external rotation (eg, nondomi-
Fracture type groups
nant arm of violin player) already noted by Sarmiento A: Simple fractures 7/29* 24.1%
et al.22 B: Wedge fractures 9/13 69.2%
C: Complex fractures 4/6 66.7%
Failure of conservative treatment B and C 13/19* 68.4%

In 6 patients in the monotrauma group (11.1%)
and in 3 patients in the polytrauma group (23.1%),
bracing failed (n ⫽ 9). One patient in the mono-
trauma group had already been treated for general-
ized severe osteoporosis and idiopathic psycho-
organic syndrome before injury. Two of the
polytraumatized patients suffered from additional
fractures of the forearm and hand on the ipsilateral
side, a situation that is currently accepted as a con-
traindication for functional bracing. One additional
patient had a fracture of the contralateral humeral
epicondyle and needed crutches to walk because of a
lower limb fracture of the opposite side. Of the 9
nonunions, 5 were transverse fractures (type A3) of
the middle third of the humeral shaft. Operation was
indicated for significant axial deformity with diastasis
of the fracture ends 5 months after injury (5 cases)
and for relatively severe axial deformation with dias-
tasis of the fracture 4 weeks after injury (3 cases).
*P ⬍ .01 (␹2).
There was 1 hypertrophic nonunion 9 months after
injury. In 1 patient, osteosynthesis was complicated
by an additional iatrogenic radial nerve palsy, which
healed spontaneously after 2 years. Postoperative
treatment of the patient with generalized osteoporosis
and idiopathic psycho-organic syndrome was very
difficult because of a lack of compliance; thus, the
final unsatisfactory result was not surprising. The op-
erative results were excellent or good in 8 cases and
unsatisfactory in 1 case.
DISCUSSION
In this series, 58 of 67 conservatively treated hu-
meral shaft fractures (87%) healed without operative
intervention. Compared with most other studies, a
148 Koch et al J Shoulder Elbow Surg
March/April 2002

Table IV Overview of the limitation in range of motion for the different movements. Note the accumulation for external rotation deficit
between 10° and 20° (n ⫽ 48)

Normal
range Deficit in range of motion

Movements 0° 5° 10° 15° 20° 30° 40° 45°

Shoulder
Abduction 43 — 4 — 1 — — —
Adduction 47 1 — — — — — —
Internal rotation 48 — — — — — — —
External rotation 34 — 8 3 3 — — —
Anteversion 41 — 4 1 1 — — 1
Retroversion 48 — — — — — — —
Elbow
Flexion 43 2 1 1 — — 1 —
Extension 45 2 1 — — — — —

Table V Isolated (monotrauma) versus polytrauma associated fractures

Monotrauma (n ⴝ 54) Polytrauma (n ⴝ 13)

Mean age (y) 39.0 23.1

Fracture type
A 32 8 (1 A2; 7 A3)
B 14 3
C 8 1
Additional injuries 3 Open fractures 1 Open fracture
4 Primary radial nerve palsies 1 Incomplete plexus palsy
Time of immobilization (d) 11.4 13.5
Conservative treatment failure 6 (11.1%) 3 (23.1%)
Conservatively healed fractures n ⫽ 48 (88.9%) n ⫽ 10 (76.9%)
Re-fractures 1 1
Time to clinical consolidation (wk) 9.9 10.6
Inability to work (wk) 11.3 15.7
Time of treatment (consolidated humerus) (wk) 25.6 31.6
Radiographic results
Axial deformation ⬎10° 20 Cases (41.7%) 8 Cases (80%)
Time to radiologic consolidation (wk) 25.4 33.3
Functional results
Shoulder
Symmetric 28 (58.3%) 8 (80%)
Measurable limited 20 (41.7%) 2 (20%)
Elbow
Symmetric 42 (87.5%) 8 (80%)
Measurable limited 6 (12.5%) 2 (20%)
Summary
Excellent results 24 Cases (50%) 6 Cases (60%)
Good results 22 Cases (45.8%) 3 Cases (30%)
Unsatisfactory results 2 Cases (4.2%) 1 Case (10%)
Poor results — —

very high proportion of initially treated patients could
be reviewed, and this may explain the relatively high
rate of failures (13.4%) compared with other series.
Of those fractures that healed without intervention,
52% had an excellent result, 43% had a good result,
and 5% had a fair result. Of 9 patients in whom
conservative treatment failed, 8 obtained an excellent
or good result with delayed operative treatment.
The mean time of almost 10 weeks until clinical
consolidation after an isolated humeral shaft fracture
may seem long, but most published studies do not
define the exact time when the fracture is considered
to be healed, so we believe that our results are
probably comparable with those of other studies.
The exact site of the fracture has been considered
to be important for the time to healing and for the
frequency of development of malalignment; whereas
healing has been found to be longer for fractures of
J Shoulder Elbow Surg
Volume 11, Number 2
the distal third in 1 study,6 other authors30 have
reported that the middle third tends to require more
time to heal. Although the group of mid-diaphyseal
fractures is relatively small in this series, it appears
that the middle third heals more slowly than fractures
of the distal third and does result in a higher propor-
tion of delayed unions or nonunions.
The type of fracture has also been associated with
specific healing problems; we could not identify an
increase in mean healing time or in the frequency of
malalignment for short oblique and transverse frac-
tures (type A2 and A3 fractures of the AO/ASIF
classification15) versus longer fractures for those
cases that did heal, but 6 of our 9 nonunions were
transverse fractures, which confirms the skepticism of
others regarding functional bracing of transverse frac-
tures.16,17,27 To conclude that such fractures should
not be braced, however, seems unjustified, as 73% of
the transverse fractures (n ⫽ 22) and 100% of the
short oblique fractures (n ⫽ 5) healed uneventfully.
We think, however, that if a diastasis of the fracture
ends persists or if axial deformity is greater than 25°,
operative intervention should be considered. Overall,
the simple type A fractures healed significantly earlier
than types B and C. We think that this is most likely
related to the fact that the latter injuries are usually
incurred with higher energy trauma causing more
extensive soft tissue disruption and possibly slower
formation of callus.24 The anatomic results of this
series are similar to other studies.* Varus deformity
was observed most frequently but was subjectively
irrelevant for all patients. Functionally, an excellent
outcome was confirmed in this study, as was a poten-
tially limiting loss of external rotation (eg, nondomi-
nant arm of violin player) already noted by Sarmiento
et al.22 Primary radial nerve palsies (7.4%, n ⫽ 54)
remain a concern. We can add 4 further cases to the
literature1,19 in which purely conservative treatment
has resulted in full functional recovery of the limb and
in which the palsy did not lead to complications of
healing of the fracture.
The discussion about conservative treatment of
patients suffering from polytrauma is fairly contro-
versial. Supporters of the bracing meth-
od6,10,13,16,18,22,29,30 emphasize the nonproblem-
atic technique, as well as the early functional
mobilization, even when there are other opera-
tively treated injuries. Although the reported results
are good, the severity of associated injuries is not
always known. Authors5,20,21,23,24,27 preferring
osteosynthesis for humeral shaft fractures in poly-
trauma patients point out the earlier and more
comfortable return to upper arm function as well as
the better comfort for postoperative care. This study
cannot substantially contribute to the question
*References 4, 6, 10, 12, 13, 18, 20, 22, 29, 30.
Koch et al 149
whether bracing or osteosynthesis should be pre-
ferred in polytrauma patients. The nonunion rate
was higher in polytrauma patients, but secondary
treatment was not problematic, so immediate inter-
nal fixation is certainly not a top priority. On the
other hand, almost all of our 10 patients had a
significant limitation in range of motion for the
elbow and shoulder, requiring intensive and long-
term physical therapy, which eventually resulted in
satisfactory results. These results were better than
those in the monotrauma group, presumably be-
cause the patients in the polytrauma group were
younger. Two of our treatment failures were in
patients with a floating elbow, which is currently
considered a poor indication for bracing.2 Our
results would support that floating elbow and the
need to use crutches are factors that are not favor-
able for bracing. Other factors in this series were
extension into the subcapital zone in 2 cases and
inability to comply with treatment in 1 psychotic
patient.
This study has confirmed that Sarmiento’s method
of early functional bracing is a technically easy and
elegant way to obtain good and excellent results for
95% of the patients, without any relevant treatment
morbidity and with a very good potential to treat
failures safely and with success by operative means.
Therefore, we believe that functional bracing remains
the gold standard and the first treatment of choice for
humeral shaft fractures and that new, allegedly less
invasive operative methods have to be compared
with functional bracing before their use becomes
more widespread.
REFERENCES
1. Alnot JY, Le Reun D. Traumatic lesions of the radial nerve of the
arm [in French]. Rev Chir Orthop Reparatrice Appar Mot 1989;
75:433-42.
2. Bleeker WA, Nijsten MWN, ten Duis HJ. Treatment of humeral
shaft fractures related to associated injuries. Acta Orthop Scand
1991;62:148-53.
3. Böhler L. Gegen die operative Behandlung von frischen Ober-
armschaftbrüchen. Langenbecks Arch Klein Chir 1964;3:465-
75.
4. Camden P, Nade S. Fracture bracing the humerus. Injury 1992;
23:245-8.
5. Chapman JR, Henley MB, Agel J, Benca PJ. Randomised prospec-
tive study of humeral shaft fracture fixation. intramedullary nails
versus plates. J Orthop Trauma 2000;14:162-6.
6. Dufour O, Beaufils P, Ouaknine M, Vives P, Perreau M. Functional
treatment of recent fractures of the humeral shaft using the Sar-
miento method [in French]. Rev Chir Orthop Reparatrice Appar
Mot 1989;75:292-300.
7. Gustilo RB, Anderson JT. Prevention of infection in the treatment of
one thousand and twenty-five open fractures. retrospective and
prospective analyses. J Bone Joint Surg Am 1976;58:453-8.
8. Gustilo RB, Mendoza RM, Williams DN. Problems in the man-
agement of type III (severe) open fracturesa new classification of
type III open fractures. J Trauma 1984;24:742-6.
9. Holstein A, Lewis GB. Fractures of the humerus with radial nerve
paralysis. J Bone Joint Surg Am 1963;45:1382-8.
150 Koch et al
10. Kayser M, Muhr G, op den Winkel R, Ekkernkamp A. Functional
treatment of fractures of the humerus using the method of Sar-
miento. Results after 3 years’ experience [in German]. Un-
fallchirurg 1986;89:253-8.
11. Kujat von R, Tscherne H. Conservative fracture treatment by
Sarmiento’s brace. Zentralbl Chir 1984;109:1417-23.
12. Kulenkampff HA, Rustemeier M. Clinical experiences in the treat-
ment of humeral shaft fractures with the Sarmiento brace [in
German]. Unfallchirurg 1988;14:191-8.
13. Langenberg R. Humerus shaft fractures-results and experience
from functional treatment according to Sarmiento [in German].
Zentralbl Chir 1987;112:1271-7.
14. Lehmann A, Raemy H. Functional treatment of humerus fractures
by Sarmiento’s method [in German]. Helv Chir Acta 1980;47:
97-101.
15. Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive
classification of fractures of long bones. Berlin: Springer-Verlag;
1990.
16. Nast-Kolb D, Schweiberer L. Changes and progress in the frac-
ture treatment of the humeral shaft [in German]. Orthopäde
1989;18:208-13.
17. Nast-Kolb D, Knoefel WT, Schweiberer L. Treatment of humeral
shaft fractures. Results of a prospective multicenter AO study [in
German]. Unfallchirurg 1991;94:447-54.
18. Peeters PM, Oostvogel HJM, Bongers KJ, van der Werken C.
Early functional treatment of humerus shaft fractures by the Sar-
miento method [in German]. Akt Traumatol 1987;17:150-2.
19. Pollock FH, Drake D, Bovill EG, Day L, Trafton PG. Treatment of
radial neuropathy associated with fractures of the humerus. J Bone
Joint Surg Am 1981;63:239-43.
J Shoulder Elbow Surg
March/April 2002
20. Rader L, Tausch W. Functional conservative treatment of humerus
shaft fracture with the plaster brace. Zentralbl Chir 1991;116:
525-30.
21. Rommens PM, Blum J, Runkel M. Retrograde nailing of humeral
shaft fractures. Clin Orthop 1998;350:26-39.
22. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG.
Functional bracing of fractures of the shaft of the humerus. J Bone
Joint Surg Am 1977;59:596-601.
23. Sarmiento A, Latta LL. Functional fracture bracing. tibia, humerus
and ulna. Berlin: Springer-Verlag; 1995.
24. Sarmiento A, Horowitch A, Aboulafia A, Vangsness CT. Func-
tional bracing for comminuted extra-articular fractures of the distal
third of the humerus. J Bone Joint Surg Br 1990;72:283-7.
25. Sarmiento A, Latta LL. Functional fracture bracing. J Am Acad
Orthop Surg 1999;7:66-75.
26. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Func-
tional bracing for the treatment of fractures of the humeral diaph-
ysis. J Bone Joint Surg Am 2000;82:478-86.
27. Sonneveld GJ, Patka P, van Mourik JC, Broere G. Treatment of
fractures of the shaft of the humerus accompanied by paralysis of
the radial nerve. Injury 1987;18:404-6.
28. Wallny T, Westermann K, Sagebiel C, Reimer M, Wagner UA.
Functional treatment of humeral shaft fractures. indications and
results. J Orthop Trauma 1997;11: 283-7.
29. Wasmer G, Wörsdörfer O. Management of humeral shaft frac-
tures with the Sarmiento cuff [in German]. Unfallheilkunde 1984;
87:309-15.
30. Zagorski JB, Latta LL, Zych GA, Finnieston AR. Diaphyseal frac-
tures of the humerus. Treatment with prefabricated braces. J Bone
Joint Surg Am 1988;70:607-10.