MAKING HUMERAL FRACTURE BRACES USING PVC PIPES

Functional bracing has been a widely-accepted practice in the management of humeral shaft fractures. Pre-made, commercially-available functional braces has replaced the traditional U- or sugar tong mold made from plaster of Paris because these braces allow for movement, are easy to apply, and last longer than POP (plaster or Paris).

 

The picture (above) and table (below) aptly summarizes the good and bad points of

the two types of braces for the conservative treatment of humeral shaft 

  fractures.

                                     

     However, such commercial braces are neither widely available nor affordable for a significant number of the (third world) population. Our institution has started exploring the use of a modified functional brace using low cost PVC pipe in lieu of expensive thermoplastic.

         The picture above shows the different components of the fracture brace. The Lateral and Medial Plates are made from 4" PVC pipes, cut into a third of its circumference (i.e., 10.5cm wide). The Plastic Liner is a 1mm thick plastic sheet taken from a long-sized plastic folder. Slots are placed so the two 1.5"(37-40mm) Elastic Straps can be threaded from the Medial Plate through the Plastic Liner, holding the two parts together. The hook velcro squares are separate so as to be positioned independently along the loop side of the velcro strap, thus increasing the size range in which it can be used. The elastic (garter) part of the strap ensures a constantly-adjusting fit, even when the patient flexes or extends the elbow (where arm diameter increases and decreases, respectively). For best results, the patient first wears a cloth liner (not shown) in his arm. The liner, made from a sock or a cut sleeve from an old sweater,  wicks away the sweat and adds to the wearer's comfort considerably.  

          Here is the PVC fracture brace assembled:

          

          How to use the brace:  Acutely, the humeral shaft fracture is placed in a velpeau bandage sling or a sugar tong splint. After two weeks, when the fracture site is starting to gel, the PVC fracture brace is applied, and the patient is advised to use the arm (i.e., by moving both elbow and shoulder). 

         

All pictures were taken with patients' permission.

          In the 14 patients where we used the PVC brace, the fracture healed within an average of 11 weeks, and the bone alignment were within the acceptable limit. All patients were very satisfied with the results.

          The PVC functional cast brace is an effective, low cost alternative to commercial functional braces in places where commercial braces are neither available nor affordable. It can be easily manufactured using local labor and materials, and allows the patient (especially if he/she is the breadwinner) to get back to work faster than the traditional sugar tong slab or hanging cast. The design also proves to be robust, modular (component parts can be switched depending on patient size), washable, paintable, comfortable, and cheap (production cost is around $2-6, depending on labor costs).

           Here are the templates if you want to make a brace for your patients.If you prefer a PDF copy, please contact me at kimjingco@yahoo.com.