Humerus fractures: selecting fixation for a successful outcome
Summary:. Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and pat...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-06-01
|
| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000259 |
| _version_ | 1797770586687012864 |
|---|---|
| author | Utku Kandemir, MD, FACS, FAAOS Emily H. Naclerio, MD Michael D. McKee, MD, FRCS(C) David J. Weatherby, MD Peter A. Cole, MD Kevin Tetsworth, MD, FRACS |
| author_facet | Utku Kandemir, MD, FACS, FAAOS Emily H. Naclerio, MD Michael D. McKee, MD, FRCS(C) David J. Weatherby, MD Peter A. Cole, MD Kevin Tetsworth, MD, FRACS |
| author_sort | Utku Kandemir, MD, FACS, FAAOS |
| collection | DOAJ |
| description | Summary:. Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union. |
| first_indexed | 2024-03-12T21:24:20Z |
| format | Article |
| id | doaj.art-0b6b72b9a3a3461e8cfb7555866e39cf |
| institution | Directory Open Access Journal |
| issn | 2574-2167 |
| language | English |
| last_indexed | 2024-03-12T21:24:20Z |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj.art-0b6b72b9a3a3461e8cfb7555866e39cf2023-07-28T09:30:28ZengWolters KluwerOTA International2574-21672023-06-0163S10.1097/OI9.0000000000000259OI90000000000000259Humerus fractures: selecting fixation for a successful outcomeUtku Kandemir, MD, FACS, FAAOS0Emily H. Naclerio, MD1Michael D. McKee, MD, FRCS(C)2David J. Weatherby, MD3Peter A. Cole, MD4Kevin Tetsworth, MD, FRACS5a Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CAb Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZb Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZc Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MNc Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MNf Royal Brisbane and Women's Hospital, Brisbane, Australia; andSummary:. Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union.http://journals.lww.com/10.1097/OI9.0000000000000259 |
| spellingShingle | Utku Kandemir, MD, FACS, FAAOS Emily H. Naclerio, MD Michael D. McKee, MD, FRCS(C) David J. Weatherby, MD Peter A. Cole, MD Kevin Tetsworth, MD, FRACS Humerus fractures: selecting fixation for a successful outcome OTA International |
| title | Humerus fractures: selecting fixation for a successful outcome |
| title_full | Humerus fractures: selecting fixation for a successful outcome |
| title_fullStr | Humerus fractures: selecting fixation for a successful outcome |
| title_full_unstemmed | Humerus fractures: selecting fixation for a successful outcome |
| title_short | Humerus fractures: selecting fixation for a successful outcome |
| title_sort | humerus fractures selecting fixation for a successful outcome |
| url | http://journals.lww.com/10.1097/OI9.0000000000000259 |
| work_keys_str_mv | AT utkukandemirmdfacsfaaos humerusfracturesselectingfixationforasuccessfuloutcome AT emilyhnacleriomd humerusfracturesselectingfixationforasuccessfuloutcome AT michaeldmckeemdfrcsc humerusfracturesselectingfixationforasuccessfuloutcome AT davidjweatherbymd humerusfracturesselectingfixationforasuccessfuloutcome AT peteracolemd humerusfracturesselectingfixationforasuccessfuloutcome AT kevintetsworthmdfracs humerusfracturesselectingfixationforasuccessfuloutcome |