Humeral Shaft Fractures Pathway Posted: 7/5/2022 ID: (C102067) Middle Atlantic Shoulder & Elbow Society Annual Meeting

Distal Humeral Shaft Fracture in 22F

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PRESENTATION
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OUTCOMES
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VIDEOS
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EVIDENCE
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Comments
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CASE DESCRIPTION
AGE 22 / Female
CC Right arm pain
HPI A 22-year-old female, right-hand dominant, presented to the ED after being involved in an arm wrestling match where she noticed immediate pain and deformity of her right arm. She denied pain in her other extremities or any numbness or tingling to the right upper extremity. A reduction is performed by the emergency room physician and the patient is placed in a splint and post-reduction films taken.
PMH There is no relevant past medical history.
PE A focused physical examination of the right upper extremity showed obvious deformity with bony crepitus just proximal to the elbow without any open wounds. She had good pulses and a normal capillary refill. The compartments were soft and compressible. A careful exam of the median, ulnar, and radial nerve showed normal function and no deficits.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/102067/ee1a4cf1-88c7-458f-ac34-e55cceaf92e8_fw1.jpg https://upload.orthobullets.com/cases/102067/b2301c70-fc88-4271-b541-86118465702b_fw2.jpg https://upload.orthobullets.com/cases/102067/fab0dbcf-a093-4cb4-91dc-6ae9c5a94ae9_fw3.jpg https://upload.orthobullets.com/cases/102067/a5097418-17d0-4561-86b9-5d0ec2922771_fw4.jpg https://upload.orthobullets.com/cases/102067/c0531e52-8f8d-42ca-82b8-1d1bc7949f9f_fw5.jpg https://upload.orthobullets.com/cases/102067/e361c544-4c9f-4a64-9c27-0c0a1fa6034a_pr1.jpg https://upload.orthobullets.com/cases/102067/bbce48f0-1f45-4487-8d69-c007328f8ed1_pr2.jpg
POLLS
OB Community
1) In addition to injury AP and LAT radiographs (without brace), would you obtain any additional imaging to guide your treatment?
Other
2) How would describe this fracture pattern?
Other
3) If you choose Nonoperative management as definitive treatment, what technique would you choose?
Other
4) How would you manage this injury?
Other
5) If you choose Operative management, how would you manage the injury?
Other
6) If you choose ORIF Alone, what surgical approach would you use?
Other
7) If you choose ORIF Alone with a Posterior Approach, how would you address the triceps?
Other
8) If you choose ORIF Alone with a Posterior Approach, what nerves would you identify and secure during the procedure?
Other
9) If you choose ORIF Alone with a Posterior Approach, what fixation technique would you use?
Other
10) If you choose ORIF Alone with a Posterior Approach with plate fixation, which plate configuration would you use?
Other
11) If you choose ORIF and obtained the construct below, would you immobilize the patient postoperatively?
Other
12) If you choose ORIF and obtained the construct below, what weight bearing status would you assign the patient postoperatively?
Other
CASE OUTCOMES
PROCEDURE 1: Open Reduction Internal Fixation Right Humerus with Posterior approach (CPT 24515)
DOP: 6/21/2022
Intra-procedure P1
https://upload.orthobullets.com/cases/102067/323438d3-f266-4f7c-8347-26ccd84931e9_identification_of_radial_nerve_just_proximal_to_fx_site.jpg https://upload.orthobullets.com/cases/102067/0e46c6a0-a6a2-411f-aac8-e69ea3a0e9c9_reduction_of_fracture_and_fixation_with_lag_screws.jpg https://upload.orthobullets.com/cases/102067/a3fafcdc-9b4e-465b-a18b-761f8724280d_selection_of_10_hole_plate.jpg https://upload.orthobullets.com/cases/102067/f5df285b-304d-4057-809b-8810de0071fe_radial_nerve_free_of_plate_entrapment.jpg https://upload.orthobullets.com/cases/102067/f0df95ee-95d1-4aa9-adf4-b1d0a2ce7be8_ulnar_nerve_intact_at_end_of_case.jpg https://upload.orthobullets.com/cases/102067/c13d54aa-9e78-48bd-a100-c3512554fa18_final_intraop_construct.jpg https://upload.orthobullets.com/cases/102067/2501c7f7-651d-4c03-a792-fb8f968a5d40_final_radiograph_lat.jpg
Post-procedure P1
10 days Post-procedure P1
https://upload.orthobullets.com/cases/102067/c6bc54fe-6828-4635-9ab5-56a7b86df60b_7.1.22_postop.jpg https://upload.orthobullets.com/cases/102067/9b1ee887-b4b3-431e-9d31-7064d28434c9_7.1._post_op_2.jpg
Post-procedure P1
24 days Post-procedure P1
https://upload.orthobullets.com/cases/102067/3eb6a44d-c3b9-4520-a36d-4872700e6a55_postop_3.jpg https://upload.orthobullets.com/cases/102067/3ba8d5db-e3dc-4439-a843-ec1ae4f9509e_post_op_4.jpg
VIDEOS & PODCASTS (8)
All Videos (8) Podcasts (0)
Humeral Shaft Fractures 2 - Surgical techniques (OTA lecture series III u04b)
  • Trauma
7/5/2022
885 views
5.0
(2)
Humeral Shaft Fractures - John Callaghan, MD
  • Trauma
7/5/2022
515 views
5.0
(1)
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Orthopaedic Summit Evolving Techniques 2020
The Reproducible Humeral Exposure: 7 Tips, 7 Minutes - Joseph Iannotti, MD
  • Trauma
  • - Humeral Shaft Fractures
A
1/27/2022
625 views
4.5
(2)
EVIDENCE (51)
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