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Non-operative management of the humerus and plating of the femur
0%
14/4288
Plating of the humerus and intramedullary nailing of the femur
85%
3638/4288
Non-operative management of the humerus and intramedullary nailing of the femur
11%
461/4288
Plating of both the humerus and femur
1%
46/4288
Intramedullary nailing of the humerus and plating of the femur
2%
96/4288
Select Answer to see Preferred Response
The clinical scenario involves a polytrauma patient with ipsilateral humerus and femur fractures. The humerus should be plated to facilitate early weight bearing, allowing for mobilization with crutches. Humeral shaft fractures account for 3-5% of all fractures and follow a bimodal distribution. Most humerus fractures can be treated non-operatively with a coaptation splint, followed by functional bracing. However, a strong relative indication for surgical management is a polytrauma patient. Plating of humerus fractures has high union rates and facilitates early weight bearing, which is necessary for rehabilitation with a concomitant lower extremity injury. Bell et al. retrospectively reviewed the outcomes of polytrauma patients treated with plate fixation for humeral shaft fractures. All but one of the fractures united, and patients had excellent function following surgery, allowing early weight-bearing through the injured extremity. Heineman et al. recently updated their systematic review of randomized controlled trials comparing plating with intramedullary nailing for humeral shaft fractures. They conclude that current literature supports a reduction in complication rates when plating humeral shaft fractures compared to intramedullary nailing. Tingstad et al. performed a retrospective study evaluating immediate weight-bearing with plated humeral shaft fractures. They demonstrated that ORIF of humeral shaft fractures followed by early weight-bearing was safe and efficacious. Figure A is an AP x-ray of a left humeral shaft fracture. Illustration A shows the diaphyseal humerus fracture from Figure A following ORIF with a plate. Incorrect Answers: Answers 1 and 3: Non-operative management of the humerus would delay rehabilitation of this patient. Answers 4 and 5: Midshaft femur fractures should be treated with intramedullary nailing to facilitate early weight-bearing.
3.7
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