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Humeral Shaft Fracture ORIF 24515

humeral shaft fracture xray

shoulder cross section picture

humeral shaft anatomy

humeral-shaft-approaches

humeral shaft posterior approach

humeral shaft ORIF picture

synonyms:

Humeral Shaft ORIF CPT Code

Humeral Shaft ORIF Anatomy

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

Humeral Shaft ORIF Indications

  • Multi trauma
  • Floating shoulder
  • Floating elbow
  • Bilateral humerus fractures
  • Nonunion
  • Open fracture
  • Vascular injury
  • Neurologic injury / brachial plexus injury
  • Obesity
  • Pathologic fx (consider IM nail)
  • Segmental fracture
  • Progressive radial N palsy
  • Distal intraarticular fx

Humeral Shaft ORIF Contraindications

  • Low-velocity GSW is not an indication
  • Active infection
  • Medically unstable patient

Humeral Shaft ORIF 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 Planning / Special Considerations

  • Ensure adequate plate is available: 4.5mm broad locking plate
  • Screws should be placed in different planes because osteons of humerus are in creating stress riser like splitting log
  • If treating Humeral shaft nonunion ensure ICBG (Ring D, JBJS 2000;82Br:867) or DBM (Hierholzer C, JBJS 2006;88A:1442) is available.

Humeral Shaft ORIF 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 ORIF 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 ORIF Follow-up care

  • Post-op: Posterior splint, NWB.
  • 7-10 Days: Remove splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Consider Humeral fracture brace.
  • 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.
  • Immediate weight bearing on a plated humerus fx with the use of crutches of a walker has been shown to safe. (Tingstad, J Trauma 2000;49:278).
  • Shoulder Outcome measures.
  • Elbow Outcome measures.

Humeral Shaft ORIF Outcomes

  • 100% union in multiply-injured patients, 80% union for nonunions. (Foster RJ, JBJS 1985;67:857).

Humeral Shaft ORIF Review References

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