Comparison of Early Bracing Versus Splinting for the Initial Treatment of Acute Humeral Shaft Fractures (The COBRAS Trial).

Study Summary

80 patients with acute, closed humeral shaft fractures were randomized to receive initial coaptation splinting followed by delayed Sarmiento functional bracing or immediate Sarmiento bracing, with 58 patients included in the final analysis. The primary outcome was daily pain intensity measured using a numerical rating scale (NRS; 0–10). Secondary outcomes included skin-related complications, cumulative opioid consumption, Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores, and patient satisfaction. Outcomes were assessed over 10 days following injury, with functional outcomes and satisfaction evaluated on day 7. Overall, the results of the study revealed that immediate Sarmiento bracing was associated with significantly greater pain and more frequent skin complications compared with initial coaptation splinting, without significant improvements in function, analgesic consumption, or satisfaction. These findings supported initial coaptation splinting followed by delayed functional bracing to improve patient comfort and minimize complications during early fracture management.