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
- Open fracture
- Vascular injury
- Neurologic injury / brachial plexus injury
- 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.
- 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.