Złamania trzonu kości ramiennej kiedy nie operować?
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1 Złamania trzonu kości ramiennej kiedy nie operować? Jakub Kamiński, Damian Kusz.
2 Humeral shaft fractures when not to operate? Jakub Kamiński, Damian Kusz.
3 Humeral shaft fx general considerations Incidence 3-5%
4 Humeral shaft fx general considerations Incidence 3-5% 20% of all humeral fractures
5 Humeral shaft fx general considerations Incidence 3-5% 20% of all humeral fractures Bimodal age distribution
6 Humeral shaft fx general considerations Incidence 3-5% 20% of all humeral fractures Bimodal age distribution Good soft tissue envelope
7 Humeral shaft fx conservative treatment 33-90% of humeral shaft fractures are reported to be treated conservatively
8 Humeral shaft fx conservative treatment 33-90% of humeral shaft fractures are reported to be treated conservatively Union rate 90%
9 Humeral shaft fx why not to operate? Patient not fit for surgery
10 Humeral shaft fx why not to operate? Patient not fit for surgery Extreme osteoporosis
11 Humeral shaft fx why not to operate? Patient not fit for surgery Extreme osteoporosis Consider possible complications (nonunion, iatrogenic radial nerve palsy, shoulder pain and limited shoulder ROM, decreased elbow ROM, complications related to anaesthesia)
12 Humeral shaft fx alignment criteria for conservative treatment <30 varus/valgus angulation
13 Humeral shaft fx alignment criteria for conservative treatment <30 varus/valgus angulation <20 anterior angulation
14 Humeral shaft fx alignment criteria for conservative treatment <30 varus/valgus angulation <20 anterior angulation < 3cm shortening
15 Humeral shaft fx alignment criteria for conservative treatment <30 varus/valgus angulation <20 anterior angulation < 3cm shortening Radial nerve palsy is NOT a contraindication for conservative treatment
16 Humeral shaft fx conservative treatment Coaptation splint (U-cast) and functional bracing
17 Humeral shaft fx absolute indications for operative treatment Open fracture
18 Humeral shaft fx absolute indications for operative treatment Open fracture Vascular injury requiring repair
19 Humeral shaft fx absolute indications for operative treatment Open fracture Vascular injury requiring repair Brachial plexus injury
20 Humeral shaft fx absolute indications for operative treatment Open fracture Vascular injury requiring repair Brachial plexus injury Ipsilateral forearm fracture (floating elbow)
21 Humeral shaft fx absolute indications for operative treatment Open fracture Vascular injury requiring repair Brachial plexus injury Ipsilateral forearm fracture (floating elbow) Compartment syndrome
22 Humeral shaft fx relative indications for operative treatment Bilateral humerus fracture
23 Humeral shaft fx relative indications for operative treatment Bilateral humerus fracture Polytrauma or associated lower fx (early weight bearing)
24 Humeral shaft fx relative indications for operative treatment Bilateral humerus fracture Polytrauma or associated lower fx (early weight bearing) Pathologic fractures
25 Humeral shaft fx relative indications for operative treatment Bilateral humerus fracture Polytrauma or associated lower fx (early weight bearing) Pathologic fractures Burns or soft tissue injury that precludes bracing
26 Humeral shaft fx relative indications for operative treatment Bilateral humerus fracture Polytrauma or associated lower fx (early weight bearing) Pathologic fractures Burns or soft tissue injury that precludes bracing Fracture characteristics: - distraction at fracture site - short oblique or transverse fracture pattern - segmental fracture
27 Humeral shaft fx operative treatment ORIF with plating (compresion plate, bridge plating, neutralization plating)
28 Humeral shaft fx operative treatment ORIF with plating (compresion plate, bridge plating, neutralization plating) Intramedullary nailing (antegrade IMN, retrograde IMN)
29 Humeral shaft fx operative treatment ORIF with plating (compresion plate, bridge plating, neutralization plating) Intramedullary nailing (antegrade IMN, retrograde IMN) External Fixator
30 Humeral shaft fx the take-home message Conservative treatment of humerał shaft fx is recomended for majority of patients Only some fx will require surgical treatment Radial nerve palsy is NOT a contraindication for conservative treatment
31 Thank you.
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