Orthopedics Today Hawaii

Orthopedics Today Hawaii

Source:

Mighell MA. Operative management of humeral shaft fractures: Plating. Presented at: Orthopedics Today Hawaii. Jan. 9-13, 2022; Waikoloa, Hawaii.


Disclosures: Mighell reports being a paid consultant for DJ Orthopaedics and Stryker; being a paid presenter or speaker for DePuy, DJ Orthopaedics, Stryker and Wright Medical Technology; receiving research support from DJ Orthopaedics; receiving royalties from NewClip Technics; and being a board or committee member for the Foundation for Orthopaedic Research and Education.
January 14, 2022
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Speaker: Plating is the ‘gold standard’ for operative fixation of humeral shaft fractures

Source:

Mighell MA. Operative management of humeral shaft fractures: Plating. Presented at: Orthopedics Today Hawaii. Jan. 9-13, 2022; Waikoloa, Hawaii.


Disclosures: Mighell reports being a paid consultant for DJ Orthopaedics and Stryker; being a paid presenter or speaker for DePuy, DJ Orthopaedics, Stryker and Wright Medical Technology; receiving research support from DJ Orthopaedics; receiving royalties from NewClip Technics; and being a board or committee member for the Foundation for Orthopaedic Research and Education.
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WAIKOLOA, Hawaii — Plating osteosynthesis of humeral shaft fractures improves function and range of motion, reduces shoulder and elbow morbidity, and has a high union rate with low complications, according to a presenter.

“If you do plating and you do a posterior approach, the incidence of nerve injury can be 5% to 10%. As long as you see the nerve and it’s intact – you document where it is – maybe which one of the screw holes it is, you can expect it to recover,” Mark A. Mighell, MD, said in his presentation at Orthopedics Today Hawaii. “So, I think [plating] is the gold standard when I decide to do an internal fixation,” he added.

Mighell recommended using bigger plates with eight cortices on either side of the fracture, if possible. For transverse fixation, surgeons have the option to use a lag screw and a neutralization plate or to use a compression plate with a lag screw through the plate, he added.

Mark A. Mighell
Mark A. Mighell

When choosing an implant, a broad 4.5-mm limited-contact dynamic compression (LCDC) plate is most common, according to Mighell. A narrow 4.5-mm LCDC plate may be used for smaller bones, and dual plating may be required for fractures in the metaphyseal transition zone, he noted. For oldest of patients, who often have osteoporotic bone, a hybrid technique may require reduction with standard screws followed by locking screws, he said.

Several determinants will affect the operative approach including fracture level, proximity to an open wound or the radial nerve and surgeon preference, Mighell said. An anterior approach in the supine position allows for proximal extension via the deltopectoral interval; however, surgeons may find it difficult to apply plating to the lateral humeral for distal fractures, he added. A posterior approach is indicated for middle-third and distal-third fractures that require nerve exposure and can be done with a triceps slide or triceps-splitting technique. This approach allows for increased exposure of the distal shaft, but it risks denervation, Mighell said.

Overall, plating allows for a quicker return to function with predictable outcomes, Mighell concluded. Factors to keep in mind are exposure of the radial nerve, plate placing in the metaphyseal zone and a hybrid approach for the oldest of patients, he added.