Executive Editor: Chris Colton

Authors: Pol Rommens, Peter Trafton

Humeral shaft

back to skeleton

Glossary

Basic treatment techniques

Basic technique: Modular external fixation

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1 A2 A3 B1 B2 B3 C1 C2 C3
A1

Simple fractures, spiral

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; lag screw(s) with neutralization plate Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
A2

Simple fractures, oblique (>30°)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; lag screw(s) with neutralization plate Closed displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
Open reduction; compression plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
A3

Simple fractures, transverse (<30°)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; compression plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
B1

Spiral wedge fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed displaced fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Closed displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
B2

Bending wedge fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathologic fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathologic fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed displaced fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
B3

Fragmented wedge fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed displaced fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
C1

Complex spiral fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed displaced fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
C2

Segmental complex fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, proximal fragment not too small Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed displaced fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
C3

Irregular complex fractures

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment; brace Closed isolated injury, minimally displaced, cooperative patient 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
Closed reduction; antegrade nailing Adequate medullary canal, diaphyseal fracture not too proximal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; retrograde nailing Adequate medullary canal, diaphyseal fracture not too distal, pathological fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Closed reduction; bridge plating (MIO) Closed fractures, associated injuries same arm, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Displaced fractures, associated injuries same arm, associated radial nerve injury, surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
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

v1.0 2006-09-14