Summary The Skeletal Dynamics Humeral Plating Set consists of the following systems: Distal Humerus Plating System Midshaft Humerus Plating System (this topic) The Skeletal Dynamics Humeral Fixation Set contains bone plates for the repair of distal and midshaft humerus fractures. Included in the set are bone screws, K-Wires, and specialized instrumentation. Related Implants Distal Humerus Plates Medial Direct Plate Lateral Direct Plate Lateral Capitellar Plate Lateral Helical Plate Supracondylar Plate with extension for distal fractures Humeral Shaft Plates Midshaft Narrow Plate Midshaft Broad Plate Indications Peri-prosthetic fractures Humeral shaft nonunion Humeral shaft malunion Anatomy Osteology humeral shaft cross-section radial groove Anterior compartment brachialis Approach A posterior longitudinal incision, with exposure of the midshaft of the ulna through subperiosteal dissection along the dorsal aspect. Technique Exposure Expose the humerus using the optimal approach for the fracture location. Reduce Fracture Debride and reduce the fracture. Address fracture pattern using lag screws as needed. Bone clamps are useful for provisional fixation. Insert Lag Screw If the fracture does not require use of a Lag Screw, proceed to plate selection. Place the lag screw as perpendicularly as possible to the fracture line. Use the 3.5mm x 50mm Drill Bit with the tissue protector Drill Guide to drill the near cortex, Insert the 2.7mm end of the Guide into the hole previously drilled and use the 2.7mm x 50mm Drill Bit to drill through the far cortex. Countersinking the near cortex may be required to limit screw head prominence. Measure and insert the desired 3.5mm Cortex Screw. Plate Selection Select the appropriate plate type and length. Six cortices are recommended proximal and distal to the extent of the fracture. Forceps can be used to aid in plate placement or fracture reduction. If needed, use bending irons to bend the plate for precise anatomical fit. Plate Fixation Utilizing the center hole of the Drill Guide, drill a pilot hole in a chosen FreeFix® Slot on one side of the fracture. Using the FreeFix® scale of the Depth Gauge, measure then insert a 4.5mm Compression Screw (non-locking cortical screw) and tighten with the T-15 Driver. Repeat this step on the opposite side of the fracture to compress the plate to the bone. Dynamic Compression Place the drill guide in the chosen slot, ensuring the off-center hole of the guide is furthest from the fracture. Drill through the off-center hole, then measure using the depth gauge to determine the appropriate screw length. Before engaging the head of the screw with the threads of the FreeFix® slot, loosen any previously placed screws on the corresponding side of the fracture. Then tighten the screw for dynamic compression. Once the screw is fully seated, retighten any previously loosened screws. Final Plate Fixation Fill the necessary screw holes on each side of the fracture to provide the recommended minimum six cortices of stability. The thread-in drill guide can be used to insert screws at any location within the slots. Final Confirmation Confirm proper reduction, alignment and screw length with fluoroscopy. Close the incision in the usual fashion. Technical specifications Lateral Capitellar: 70mm, 100mm, 130mm, 160mm Lateral Direct: 85mm, 115mm Lateral Helical: 85mm, 115mm, 145mm, 175mm Medial Direct: 75mm, 105mm, 135mm, 165mm Screws Metaphyseal and Diaphyseal Specific Screw Options Screw Options TiBeam® Male (40mm - 80mm construct lengths) Female (40mm - 80mm construct lengths) Distal Trochlea Compression 20mm - 80mm lengths Compression/ Locking Screw 2.7mm & 3.5mm Compression (10mm - 70mm lengths) 2.7mm & 3.5mm Locking (10mm - 70mm lengths) 3.0mm Polyaxial Locking (10mm - 70mm lengths) FREEFIX® Compression/ Locking 3.5mm Compression (14mm - 44mm lengths) 3.5mm Locking (14mm - 44mm lengths)