Humeral Shaft Fractures Treatment Alternative - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes alternative treatment method for humeral shaft fractures.
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Humeral Shaft Fractures
Usually when a patient suffers from a humeral shaft fracture, the patient will complain of pain and weakness of the upper extremity. Radial nerve palsy can occur in association with the humeral shaft fracture. The clinician must examine the neurovascular status of the upper extremity. Look for wrist drop that results from radial nerve palsy, especially in fractures of the distal third of the humerus. Examination of the neurovascular status should be done before and after reduction of the fracture. The physician usually orders AP and lateral x-ray views of the humerus. X-rays should include the shoulder and elbow. Any deformity should be recognized and corrected. Most humeral shaft fractures will heal without surgery (90% will heal with conservative treatment). Non-operative treatment is usually done with a coaptation splint which can then be replaced by a functional brace once the pain subsides and then the patient can move the shoulder with the brace in place. Acceptable alignment can be obtained with or without closed reduction of the fracture. Acceptable alignment is less than 20 degrees of anterior-posterior angulation. Less than 30 degrees of varus or valgus angulation and less than 3 cm of shortening is also acceptable. Surgery is done for humeral shaft fractures if there is vascular injury that requires repair. Surgery is also done for open fractures and if there is a brachial plexus injury. In multiple trauma patients, you can use a splint or a brace acutely early during the damage control period, however, later on these patients will need fixation of their humeral shaft fracture. Multiple trauma patients always benefit from fixation of their humeral shaft fracture. Open humeral shaft fractures with radial nerve palsy are usually treated surgically, be debriding of the wound, exploring the nerve, and fixing the humeral shaft fracture. Closed humeral shaft fracture with radial nerve palsy is treated conservatively. Gunshot wounds, even cases where there is radial nerve palsy, are treated conservatively with a splint and a brace. Wait patiently, expecting recovery of the nerve. The coaptation splint should be snug, extending to the axilla and up to the shoulder. Weekly radiographs are needed for a period of3-4 weeks. The physician may check the Vitamin D-25 level. The fracture usually heals between 6-10 weeks. Observe for loss of reduction. Observe for excessive varus or extension deformity. Shoulder abduction sling may be needed to correct the varus deformity. Varus angulation is common, but it may not affect the functional outcome (may just have cosmetic effect only). If acceptable reduction cannot be obtained or maintained, surgery is usually recommended. Surgery is done in the form of an IM rod or a plate. Plate fixation is better for healing, less complications, and better weight bearing. We propose that if acceptable reduction cannot be obtained or maintained, we should not rush for surgery. Our novel technique for management of these humeral shaft fractures is to wait. Keep the splint or the brace. Check to see if the patient is making bone. As we know, bone healing goes through several stages- hematoma, inflammation, soft callus, hard callus, remodeling. We intervene when the patient has an unacceptable deformity of the fracture, but the patient is making a lot of callus. Usually we intervene between 4-6 weeks when the callus is soft, malleable, and flexible. Then we correct the deformity by manipulating the mobile callus, and we use external fixation to maintain reduction of the deformity. The external fixator may utilize one pine proximally and one pin distally. Occasionally, we will use two pins proximally and two pins distally. We keep the external fixator in place for 4-6 weeks, and by that time the fracture usually heals in an acceptable position.

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