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Humeral Shaft Fractures
Posted: Jan 18 2019 #(C101159)
A

Humeral Shaft Fx in 31M

HPI

A 31-year-old male, right-hand dominant, presents to clinic for evaluation of left arm injury. He was involved in a motor vehicle accident 1 week prior in which he also sustained multiple rib fractures as well as a splenic laceration for which he was treated with IR embolization. He denies any weakness or numbness/tingling of the hand. Of note, he is supposed to go to Japan in 4 weeks for work.

PMH

No significant past medical history

PE

Focused physical examination of the left upper extremity reveals mild swelling and bruising of the left arm without any open wounds. He has tenderness to palpation over the humeral shaft. He is neurovascularly intact.

Poll
1 of 11
1. Would you obtain any further imaging to guide treatment?
No - Current xrays are sufficient
79%
1089/1376
Yes - Additional xrays without Sarmiento brace in place
3%
45/1376
Yes - Additional xrays with Sarmiento brace in place
11%
161/1376
Yes - CT scan
2%
40/1376
Yes - CT scan + Additional xrays
0%
11/1376
Outside my area of expertise - best if I don't vote
2%
30/1376
2. How would you manage this injury?
Nonoperative management
17%
245/1381
Operative management
81%
1123/1381
Outside my area of expertise - best if I don't vote
0%
13/1381
3. If you choose Nonoperative management as definitive treatment, what technique would you choose?
I would not choose Nonoperative management
51%
661/1279
Sling now - leave until healing
1%
13/1279
Coaptation splint now - leave until healing
3%
43/1279
Sarmiento (functional) brace now - leave until healing
22%
290/1279
Coaptation splint now - in 1-2 weeks transition to Sarmiento brace and leave until healing
19%
250/1279
Outside my area of expertise - best if I don't vote
1%
22/1279
4. If you choose Operative management, what surgical technique would you choose?
I would not choose Operative Management
3%
47/1337
External Fixation only
0%
3/1337
Open reduction and internal fixation (ORIF) only
48%
648/1337
Intramedullary nailing (IMN) only
42%
570/1337
ORIF + Intramedullary nailing (IMN)
3%
48/1337
Outside my area of expertise - best if I don't vote
1%
21/1337
5. If you choose IMN, what approach would you use?
I would not choose IMN
26%
333/1274
Antegrade IMN
64%
819/1274
Retrograde IMN
6%
87/1274
Outside my area of expertise - best if I don't vote
2%
35/1274
6. If you choose ORIF only, what approach would you use?
I would not choose ORIF only
14%
177/1257
Anterior (brachialis split)
13%
168/1257
Anterolateral
41%
520/1257
Posterior
21%
264/1257
MIPO (minimally invasive plate osteosynthesis)
7%
97/1257
Outside my area of expertise - best if I don't vote
2%
31/1257
7. If you performed ORIF only, would you perform single plating or dual plating?
I would not choose ORIF only
10%
135/1232
Single Plating
81%
1004/1232
Dual Plating
5%
73/1232
Outside my area of expertise
1%
20/1232
8. If you choose ORIF only with an anterolateral approach and single plate, how would you position the patient?
I would not choose ORIF only
7%
93/1193
Lateral
9%
114/1193
Supine
47%
564/1193
Sitting Beach Chair
32%
391/1193
Other
0%
6/1193
Outside my area of expertise - best if I don't vote
2%
25/1193
9. If performing ORIF only with a single plate, what plate would you use?
I would not choose ORIF only
6%
77/1169
Small fragment (3.5mm) plating
5%
70/1169
Large fragment (4.5mm) Narrow plating
51%
607/1169
Large fragment (4.5mm) Broad plating
26%
313/1169
Long proximal humerus locking plate
5%
70/1169
Other
0%
2/1169
Outside of my area of expertise - best if I don't vote
2%
30/1169
10. If you choose ORIF only and obtained a compressed aligned construct with a large fragment plate, what would your post-operative weight-bearing status be?
I would not choose ORIF only
6%
70/1117
Weight bearing as tolerated (WBAT)
21%
241/1117
Partial weight bearing (PWB) less than 5-10 lbs
37%
414/1117
Non-weight bearing (NWB)
33%
372/1117
Outside my area of expertise - best if I don't vote
1%
20/1117
11. If you choose ORIF and obtained the construct below, what chemical DVT prophylaxis would you prescribe?
I would not choose ORIF
6%
69/1096
I would not prescribe any chemical DVT prophylaxis
65%
716/1096
Aspirin
12%
133/1096
Low molecular weight heparin (Lovenox)
11%
126/1096
Heparin transitioned to Coumadin
0%
4/1096
Xa inhibitors (Xarelto etc.)
2%
31/1096
Outside my area of expertise - best if I don't vote
1%
17/1096
PROCEDURE #1

Open reduction and internal fixation of left humeral shaft fracture with narrow large fragment plate (THIS IS NOT A RECON PLATE)

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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