Executive Editor: Chris Colton, Steve Krikler

Authors: Pol Rommens, Peter Trafton, Martin Jaeger

Humeral shaft

back to skeleton

Glossary

Simple fracture, spiral

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, adequate closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Lag screw(s) with protection plate Associated radial nerve injury, open fractures, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Simple fracture, oblique (≥30°)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, adequate closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Lag screw with protection plate Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Compression plating Associated radial nerve injury, surgeon’s preference, fracture configuration suitable for compression plating +/- lag screws Highly experienced and skilled surgeon Simple surgical and imaging resources

Simple fracture, transverse (<30°)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, adequate closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Compression plating Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Wedge fracture, intact wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, adequate closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation (proximal 1/3) Proximal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (middle 1/3) Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation (distal 1/3) Distal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Wedge fracture, fragmentary wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Some specialized surgical experience Simple surgical and imaging resources
Antegrade nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, adequate closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation (proximal 1/3) Proximal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (middle 1/3) Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation (distal 1/3) Distal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Multifragmentary fracture, intact segment

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
Antegrade nailing (proximal 1/3) Proximally extending fracture, adequate medullary canal, proximal fragment not too small, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Antegrade nailing (middle 1/3) Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture, proximal fragment not too small Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation (proximal 1/3) Proximal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (middle 1/3) Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation (distal 1/3) Distal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Multifragmentary fracture, fragmentary segment

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Closed isolated injury, minimally displaced, cooperative patient, midshaft fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Unstable fracture, unstable patient, open fracture, usually temporary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources
Antegrade nailing (proximal 1/3) Proximally extending fracture, adequate medullary canal, proximal fragment not too small, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Antegrade nailing (middle 1/3) Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal or proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Bridge plating Closed fractures where surgery is indicated, and closed reduction is possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation (proximal 1/3) Proximal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Bridge plating (middle 1/3) Associated radial nerve injury, surgeon’s preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Plate fixation (distal 1/3) Distal fracture requiring fixation, surgeon’s preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-12-28