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Closed management with a coaptation splint
6%
296/5311
Closed management with a coaptation splint followed by transition to a functional brace after 7-10 days
17%
923/5311
External fixation of humeral shaft fracture until brachial plexus injury resolves
2%
118/5311
Open reduction, surgical fixation with plating
72%
3806/5311
Closed management with a sling until brachial plexus injury resolves
121/5311
Select Answer to see Preferred Response
A coexisting brachial plexus injury is an absolute indication for open reduction and internal fixation of humeral shaft fractures. A majority of humeral shaft fractures may be treated non-operatively in a functional brace. Absolute indications of operative management include open fracture with severe soft tissue injury, vascular injury requiring repair, and a coexisting brachial plexus injury. Patients with a brachial plexus injury are more likely to go on to nonunion when treated non-operatively due to lack of muscular support controlling the fracture fragments. Sarmiento et al. review 620 patients with humeral shaft fracture treated non-operatively in a coaptation splint followed by a functional brace. Only 16 patients developed a non-union, and any residual deformity was usually functionally and aesthetically acceptable. Rutgers et al. present a retrospective case series of 49 patients who had humeral shaft fractures that were treated non-operatively in a functional brace. 44 of 49 patients went on to successful union. Fractures of the proximal third of the humeral shaft were most likely to go on to nonunion. Figure A shows a midshaft humerus fracture. Incorrect Answers: Answer 1, 2, 5: operative management is indicated with a coexisting brachial plexus injury. Answer 3: a coexisting brachial plexus injury is not an indication for external fixation of humeral shaft fractures.
4.3
(27)
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