synonyms: intramedullary nailing humerus shaft fracture
Humeral Shaft IM Nail CPT
Humeral Shaft IM Nail Anatomy
- Musculocutaneous N pierces coracobrachialis 5-8cm distal to coracoid, supplies biceps,coracobrachialis & bracialis
- See also Arm anatomy.
Humeral Shaft IM Nail 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 IM Nail Contraindications
- Low-velocity GSW is not an indication
- Active infection
- Medically unstable patient
Humeral Shaft IM Nail Alternatives
Humeral Shaft IM Nail Planning / Special Considerations
Humeral Shaft IM Nail 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 IM Nail 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 IM Nail Follow-up care
- Post-op: Posterior splint, NWB.
- 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 IM Nail Outcomes
Humeral Shaft IM Nail Review References
- Rockwood and Green's Fractures in Adults 6th ed, 2006