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.
- 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