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Humeral Shaft External Fixation

Humeral Shaft external fixation GSW

shoulder cross section

Humeral shaft bone anatomy

humeral shaft fracture xray

humeral shaft external fixation A/P xray


Humeral Shaft External Fixation Anatomy

  • Musculocutaneous N pierces coracobrachialis 5-8cm distal to coracoid, supplies biceps,coracobrachialis & bracialis
  • See also Arm anatomy.

Humeral Shaft External Fixation Indications

  • Severe open fractures with extensie soft tissue injury / bone loss
  • Associated burns
  • Infected humeral shaft nonunion
  • Associated neurovascular injury
  • Polytrauma patient with need for rapid stabilization

Humeral Shaft External Fixation Contraindications

  • Low-velocity GSW is not an indication

Humeral Shaft External Fixation Alternatives

  • Functional Bracing (Sarmiento A JBJS 2000;82A:478) (Koch PP, JSES 2002;11:143).
  • Intramedullary Fixation: increased incidence of nonunion, radial nerve injury (5%), persistent subacromial complaints (@25%). (Stannard JP, JBJS 2003;85A:2103).
  • Humeral shaft ORIF.

Humeral Shaft External Fixation Planning / Special Considerations

  • Ensure adequate fixator is available
  • Humeral Shaft Case Card
  • Consider Antibiotics beads for infected nonunions.

Humeral Shaft External Fixation Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Humeral Shaft External Fixation Complications

  • Delayed union = failure to unite in 2-3 months
  • Nonunion 4-6 months
  • Malunion, nonunion, vascular, radial N(10%),
  • Radial nerve palsy-most recover in 3-4 months, pts should be placed in cock-up wrist splint, given thumb abduction and finger/wrist extension exercises to avoid contracture.  EMG at 6 wks if no signs of recovery.  Brachioradialis should be first muscle to return.  11.1% of closed fx have associated Radial nerve palsy, 0.2% in closed fx's fail to recover.  18% open fx. 60% have nerve entrapped in fx. (Bostman O, Acta Orthop Scand 1986;57:316) . (Shaz JJ, Bhatti NA: CORR 1983;172:171. (Holstein A JBJS 1963;458:1382).

Humeral Shaft External Fixation Follow-up care

  • Post-op: Posterior splint, NWB.
  • 7-10 Days: Remove splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Consider converstin to Humeral fracture brace when soft tissues permit.
  • 6 Weeks: Begin strengthening exercises provided fracture union is evident on xray.
  • 3 Months: Ensure full restoration of shoulder and elbow ROM. Consider bone stimulator if union is delayed. Sport specific rehab.
  • 6 Months: return to full activities / sport.
  • 1Yr: Follow-up xrays, assess outcomes
  • Shoulder Outcome measures.
  • Elbow Outcome measures.

Humeral Shaft External Fixation Outcomes

Humeral Shaft External Fixation Review References

  • Rockwood and Green's Fractures in Adults 6th ed, 2006
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