Humeral Shaft Fracture Treatment - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 15 ก.ย. 2024
- Dr. Ebraheim’s educational animated video describes humeral shaft fractures, signs and symptoms, imaging and diagnostic tests, and treatment options.
There are several important points involving humeral shaft fractures:
1-Humeral shaft fractures are treated without surgery in the majority of cases. Nonoperative treatment gives a satisfactory outcome. A perfect alignment of the humerus is not important for an acceptable functional result.
2-Radial nerve palsy in not uncommon: check for neurovascular deficit before and after reduction (Especially wrist and finger extension). Holstein-Lewis fracture is commonly associated with neuropraxia of the radial nerve (Approximately 22% of cases).
3-Platting of the humerus is better with an IM rod.
Treatment
•Nonoperative is used in the majority of cases.
•Acceptable alignment
•Hanging arm cast occasionally used
•Humeral fracture brace: 7-10 days when the swelling and the pain is less.
•Functional bracing
Indications for surgery
•Open fractures •Vascular injury •Floating elbow •Loss of reduction
•Polytrauma patient •Brachial plexus injury
Surgery
•Plate fixation, more stable, less reoperation or complications. plate fixation is better than a rod
•Rod fixation: less stable, more reoperation
•External fixation: not commonly used.
Complex fracture:
types of fixation :
•plate •rod •external fixator (near fracture, away from fracture).
Anterolateral approach: in the proximal 2/3 the nerve lies posterior to the intermuscular septum, so its difficult to see the nerve. In order to see the nerve, you need to search for it between the brachialis and brachioradialis distally.
Posterior approach: is used for the distal 1/3 of the humerus.
Plating technique
•Pre-bend the plate: allows compression on the near and far cortex. Usually use 4.5 mm plate and screws. The humerus is subject to larger rotational forces. Staggered hole screw placement is ideal.
•Lag screw and neutralization plate for oblique fracture.
•Use bridge plate for comminuted fracture.
•Posterior approach for plating of fractures in the distal third of the humerus. The posterior surface is flat. Anatomically easier approach. Biomechanically better.
In general, plating of the humerus allows for immediate weight bearing with crutches or walker use.
•Locking plate •Used for osteoporotic patients •Sometimes 3.5 mm locking plate is used instead of 4.5 mm plate.
IM rod indications:
•Segmental fracture •Osteoporotic fracture •Pathological fracture
•Comminuted fracture
There is higher complication rate and shoulder pain with IM rod fixation. IM rodding will give you callus endochondral ossification. More callus than with plating.
Distal screws may have complications with plating. If you go from anterior to posterior, you risk injury to the musculocutaneous nerve.
External fixation is used in
•infected or contaminated cases with bad soft tissue injury
•Sometimes used temporarily
•Watch the position of the radial nerve when you insert the screws.
Usually three complications with humeral shaft fractures
1-Varus: common, especially after conservative treatment (does not affect function).
2-Nonunion: check 25-hydroxy vitamin D. usually plate and bone graft. If a rod has been used, remove the rod and then do plate and bone graft. If the nonunion is hypertrophic, use a compression plate alone.
3-Radial nerve palsy
Splint the wrist and obtain EMG studies in about 6 weeks. Fibrillation is bad, polyphasic is good. Monitor the brachioradialis muscle since it is the first muscle to recover. Extensor indices muscle is the last muscle to recover. Wrist extension radial deviation recovers first. Explore the nerve f the nerve fails to recover within 4-6 months.
This is best channel on youtube
Thank you
Thank you so much this video is really helpful 🙏🏼
Excellent always. Thank you very much.
Thanks you doc, and channel 😊
Amazing info. Tx.
Thanks
Bridge plating is for relative stability... Not absolute
God bless you
7 weeks and 3 days of my fracture no surgery they removed they cast but i am feeling like i am not fully healed so i cant start rehab now i am wearing a brace but i can feel improvement but not fully healed i hope that in a maximum of 3 months i woll be totally healed amwn
Hey how r u now
My mom has a proximal humerus fracture for about five weeks now, she is still wearing her sling with a strap around her fracture arm. The doctor has not recommended any exercises yet, I'm worried about her movement recovery, besides I think at this point she needs only a shoulder immobilizer and start flexing her lower arm. Please advise!
Do all upper arm fractures really require surgery? What kind of fractures definitely require surgery?
I'd like to know too, snapped my shaft in half a few days ago, would prefer not to have surgery
Bro today I got fracture in my upper arm what should I do
@@kreecha4409 how is your arm?
@@kreecha4409 how are you now did you get surgery ?
@@Animex110k how are u now bro?
What if the half of the fracture is stick to the bone the rest is stick to the muscle?
Humerus fragment fracture may cause of pulmonary embolism and death?
4month my surgery pain
Thank you what about ununion after a year treated with plate and wires surgery and EMG shows zero for radial,median,ulnar nerves
mother age 90, fell in bathroom at assisted living. Dr. missed fracture on bottom of X-ray.
The daughter saw it! Daughter told X-ray tech she saw a fracture. daughter called nurses station to have Dr. check x-ray again and nothing was done. Daughter expressed concern to Neuro doctor, Neuro doctor made joke, when did you get your degree in.... Resident present said we will check on it. Errant Dr. called me to say, we can do surgery or wrap it. You know I am worried to let a Dr who missed a fracture 'wrap' mom's arm. I am so worried.
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