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Humeral Shaft Fractures
Posted: Apr 14 2020 #(C101428)
A

Humeral Shaft Fracture in 72F

HPI

72-year-old female, right-hand dominant, presents to clinic after a ground-level fall 1 week prior. She was initially treated with a Sarmiento brace which she was unable to tolerate. She admits to some chronic pain in the right shoulder prior to this injury, but denies any current distal weakness, numbness, or tingling.

PMH

Her PMH is significant for anxiety, GERD, and previous right shoulder surgery (~40 years prior) of unclear indication.

PE

BMI 29. Her skin is intact with no impending compromise but does have mild ecchymosis and tenderness about mid-brachium with obvious fracture motion. She is neurovascularly intact distally.

Poll
1 of 11
1. In addition to plain film radiographs, would you obtain additional imaging studies to guide management?
No - Current radiographs are sufficient
59%
1254/2110
Yes - Additional radiographs without Sarmiento brace in place
5%
120/2110
Yes - Additional radiographs with Sarmiento brace in place
21%
456/2110
Yes - CT scan (CT)
8%
176/2110
Yes - CT + Additional xrays
3%
68/2110
Outside my area of expertise - best if I don't vote
1%
36/2110
2. How would you manage this injury?
Nonoperative management
33%
694/2073
Operative management
65%
1349/2073
Outside my area of expertise - best if I don't vote
1%
30/2073
3. If you choose Nonoperative management as definitive treatment, what technique would you choose?
I would not choose Nonoperative management
43%
859/1994
Sling now - leave until healing
2%
48/1994
Coaptation splint now - leave until healing
4%
98/1994
Sarmiento (functional) brace now - leave until healing
20%
404/1994
Coaptation splint now - in 1-2 weeks transition to Sarmiento brace and leave until healing
27%
542/1994
Outside my area of expertise - best if I don't vote
2%
43/1994
4. If you choose Nonoperative management (either Sling, Coaptation, Sarmiento), how long would you leave it on for?
I would not choose Nonoperative management
39%
745/1901
Until pain free at fracture site
9%
179/1901
Until Radiographic Union
13%
260/1901
2-3 weeks then remove regardless
2%
51/1901
4-6 weeks then remove regardless
20%
394/1901
7-10 weeks then remove regardless
11%
227/1901
11-12 weeks then remove regardless
1%
38/1901
Outside my area of expertise - best if I don't vote
0%
7/1901
5. If you choose Nonoperative management, how often would you perform followups on the patient?
I would not choose Nonoperative management
38%
716/1838
Weekly until fracture union
4%
78/1838
Weekly for 3 weeks, then monthly until fracture union
28%
516/1838
Every other week until fracture union
4%
91/1838
Scheduled at 2 weeks, 6 weeks, and 12 weeks
22%
414/1838
Outside my area of expertise - best if I don't vote
1%
23/1838
6. If you choose Operative management, what surgical technique would you choose?
I would not choose Operative management
8%
158/1934
Open reduction and internal fixation (ORIF) only (includes plate, screws, wires, minimally invasive plate)
50%
977/1934
Intramedullary nailing (IMN) only
28%
552/1934
ORIF + IMN
11%
217/1934
Outside my area of expertise - best if I don't vote
1%
26/1934
External Fixation
0%
4/1934
7. If you choose ORIF, what approach would you use?
I would not choose ORIF
15%
290/1844
Anterolateral
68%
1257/1844
Posterior
13%
242/1844
Outside my area of expertise - best if I don't vote
2%
55/1844
8. If you choose ORIF + IMN, what provisional fixation would you choose?
I would not choose Open reduction provisional fixation at fracture site+ IMN
38%
667/1732
Mini-frag plates
9%
159/1732
Cerclage cables
24%
432/1732
Lag screws
16%
280/1732
Combination of screws and cables
7%
132/1732
Outside my area of expertise - best if I don't vote
3%
62/1732
9. If you choose IMN, what approach would you use?
I would not choose IMN
34%
580/1674
Antegrade IMN
59%
992/1674
Retrograde IMN
3%
51/1674
Outside my area of expertise - best if I don't vote
3%
51/1674
10. If you choose ORIF only (includes plate, screws, wires, minimally invasive plate), what construct would you choose?
I would not choose ORIF at fracture site only (includes plate, screws, wires, minimally invasive plate)
18%
301/1638
Screw fixation only
1%
30/1638
Cerclage cable fixation only
0%
16/1638
Single long proximal humerus locking plate - open
47%
780/1638
Single large-frag straight plate - open
19%
325/1638
Dual plating - open
1%
28/1638
Outside my area of expertise - best if I don't vote
2%
47/1638
Minimal-invasive plating with a long proximal locking humeral plate via deltoid-split approach proximally
6%
111/1638
11. If you choose Operative management and obtained the construct below, what would your post-operative weight-bearing status be?
I would not choose IMN
24%
382/1572
Weight bearing as tolerated (WBAT)
23%
366/1572
Partial weight bearing (PWB) less than 5-10 lbs
29%
468/1572
Non-weight bearing (NWB)
20%
315/1572
Outside my area of expertise - best if I don't vote
2%
41/1572
PROCEDURE #1

Open Reduction with cerclage wire placement and Anterograde Intramedullary Nailing

icon
OUTCOMES
Post-procedure P1
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