Humeral shaft ORIF with plate and screws

Humeral shaft fractures often heal well without surgery. Some deformity is well tolerated, and is without consequences.

In cases of "excessive" displacement, surgery can be performed. Surgery can be recommended for other reasons as well, including:

  1. Exploration of the radial nerve.
  2. When other orthopedic injuries are present, in order to facilitate the overall recovery.

When quicker return to work is important for a patient, surgery may be the way to go, but... it is important to remember that surgery has risks.

Risks of humerus ORIF surgery

  1. Risks of general anesthesia apply, including death, stroke, etc.
  2. Infection
  3. Nonunion, failure of hardware, repeat surgery. Fixation with plate and screws does not guarantee healing of the bone. The plate and screws simply act as effective immobilization of the fracture. The bony break still must heal, otherwise it is simply a matter of time before the screws break or pull out.
  4. Nerve damage, especially damage to the radial nerve.
  5. Blood clots (DVT) can happen in the arm too, with or without surgery, after these fractures.
  6. Pain: some patients continue to have pain, sometimes it is not clear why.

How is the surgery done?

There are 2 ways to get to the shaft of the humerus, from the front, or from the back. By far the most common method is from the front (anterior approach). The plane of this approach is relatively safe, with minimal risk of nerve injury.

When exploration of the radial nerve is necessary, I perform the posterolateral approach as described by Dr Andy Weiland.

With either approach, xrays are used to check the position of the fragments during surgery. After the plate is applied, screws are inserted above and below the break to stabilize the fracture.

The wound layers are then closed one by one.

What is the typical recovery?

  1. Unless other injuries are present, the patient spends one night in the hospital.
  2. Immediate full motion is allowed, of course without lifting anything with the injured arm.
  3. Healing takes a minimum of 2 months
  4. Physical therapy is necessary for approximately 3 months.

Case study

In this particular case, surgical treatment was sought by the patient in order to facilitate faster return to work.

Here are the xrays of the healed fracture, at almost 4 months after surgery.

Can a fracture like this be treated without surgery?

The answer is yes.

Cast treatment is a good options for these fractures, and it is the best option if one does not wish to risk a deep orthopedic infection. Cast treatment has two drawbacks:

  1. A good number of patients get frozen shoulder from immobilization
  2. The cast and the bracing may cause skin irritation and superficial wounds.

With cast treatment, the patient has to be willing to accept some deformity, and the pain in the first 2-3 weeks is quite a bit higher than with surgery.

The fully informed patient oftentimes will prefer surgical treatment, despite the risks. In an otherwise healthy patient with a humeral shaft fracture, surgical treatment is superior except for the possibility of infection.