Humerus shaft fracture

Question 1

Absolute indications axes and displacement (4)

Answer 1

Axis: > 20 ° anterior, > 30 ° varus
Shortening : > 3 cm
Rotation: > 40° Rotation

Question 2

Relative indications

Answer 2

Transverse and short oblique fractures

Question 3

Operation Type : simple fractrues

Answer 3

ORIF compression plate

Question 4

Operation Type : multifragmentary fractures

Answer 4

MIPO bridging plate

Question 5

Operation indication for Nails

Answer 5

Transverse and Wedge
Cave : increased risk of nerve lesion
Relative indications:
- Pathologic fracture
- Segmental fracture
- Osteoporotic bone
- Skin compromise

Question 6

Approaches to the humerus

Answer 6

Anterolateral approach
- for proximal third and middle shaft fractures
Posterior approach to the humerus
- middle third to distal shaft fractures

Question 7

Anterolateral approach

Answer 7

• extension of delto-pectoral
• between brachialis (mc + rad) and brachio-radialis (rad)
• Radialis nerve situated between brachialis and brachio-radialis
• Cave lateral cuteneous nerve of the forearm distal of the incision

Question 8

Posterior approach the humerus

Answer 8

Muscle splitting approach

• between lateral and long head of the triceps
• radial nerve is found between the medial and lateral head of biceps
• crosses humerus from medial to lateral between 20cm and 15cm proximal of epicondyle

Question 9

IMN vs plating

Answer 9

• same nonunion rate
• IM more total complications
• plate more shoulder pain
• same ASES shoulder score
• Nailing more risk of nerve injury with the anterior posterior screw (MC) and lateral to medial screw (radial)

Question 10

Conservative treatment

Answer 10

Coaptation splint
90% union rate
(increased risk with proximal third oblique and spiral fracture