Humeral Shaft Fracture ORIF 24515

humeral shaft fracture xray

shoulder cross section picture

humeral shaft anatomy


humeral shaft posterior approach

humeral shaft ORIF picture


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, immediate weightbearing through the involved humerus after ORIF is safe and efficacious. (Tingstad EM, J Trauma. 2000 Aug;49(2):278-80.)
  • 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
  • Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma. 2000 Aug;49(2):278-80. 

  • Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br. 1985 Mar;67(2):293-6. 

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