Humerus, shaft: wedge fracture, bending wedge—12-B2


Humerus, shaft: wedge fracture, bending wedge—12-B2

Theerachai Apivatthakakul

Case description

A 23-year-old man had a motorcycle accident and sustained a fracture of the shaft of his left humerus (12-B2) as well as a fracture of the proximal left femur. Two years previously, the patient sustained bilateral femoral fractures which had been fixed with retrograde femoral nails. This time, the fracture of the left femur has occurred at the level of one of the proximal locking screws. The retrograde femoral nail was also broken at this level.

Indication for MIPO

Conventional plating is not suitable for comminuted fractures of the humeral shaft because it requires extensive soft-tissue dissection and bone grafting. MIPO preserves the soft tissue and blood supply with rapid callus formation.

a–b Preoperative x-rays. a A wedge fracture of left humeral shaft. b A subtrochanteric fracture at the proximal locking screws of the retrograde femoral nail.

Preoperative planning

A 10-hole narrow DCP is planned to bridge the wedge fracture on the anterior of the humerus. The middle segment is left without a cortex screw to avoid radial nerve injury.

1 Align the plate in the center of the bone. 2 Insert the first cortex screw (screw 1). 3 Insert the second cortex screw (screw 2). 4 Reduction. 5 Ensure the plate is aligned in the center of the bone. Insert the third cortex screw (screw 3). 6 Check for length, rotation, varus, and valgus. 7 Insert the fourth cortex screw (screw 4). 8 Insert the fifth and sixth cortex screws (screws 5, 6).

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Jul 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Humerus, shaft: wedge fracture, bending wedge—12-B2

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