Precautions for surgical approach of humeral shaft fracture

There are generally three causes of humeral shaft fractures, namely direct violence, indirect violence and rotational violence. Direct violence is often a transverse fracture or a comminuted fracture, and even multiple fractures may occur. Indirect violence is often an oblique fracture, but this type of fracture is easy to pierce the muscle. Rotational violence can lead to a typical spiral fracture. Humeral shaft fractures require surgery to recover. So what are the precautions for the surgical approach to humeral shaft fractures?

First, what are the precautions for surgical approach of humeral shaft fracture? Open fractures should undergo early soft tissue and bone debridement and internal fixation of the fracture. (Fractures with vascular and nerve damage should be fixed internally and the nerves and blood vessels should be repaired. (When the lower and middle thirds of the humeral shaft fractures are accompanied by an intra-articular fracture of the elbow, manual reduction and maintenance of reduction are difficult, and open reduction and internal fixation should be performed. Non-surgical treatment of bilateral humeral shaft fractures can cause inconvenience to the patient's life and difficulty in nursing. Internal fixation should be performed.

Second, for fractures that cannot be reduced satisfactorily by manipulation, such as spiral fractures, where soft tissue is embedded between the fracture ends, nonunion may occur even if the fracture alignment is satisfactory, and internal fixation should be performed. If the effect of non-surgical treatment is unsatisfactory, such as transverse fractures treated with suspension plaster, excessive traction may cause fracture non-union; if short oblique fractures are treated with non-surgical treatment and there is obvious displacement of the fracture ends, surgical internal fixation should also be performed. It is difficult to maintain satisfactory alignment of the fracture ends in non-surgical treatment of multiple injuries combined with humeral shaft fractures. Once the condition stabilizes, surgical treatment should be actively performed. Surgical treatment of pathological fractures can make patients feel more comfortable and increase upper limb function. There are several surgical treatment options.

Common complications: The most common nerve injury is radial nerve injury. Fractures of the middle and lower 1/3 of the humerus are prone to incomplete radial nerve injury due to compression or contusion of the fracture ends. Generally, if there is no recovery of nerve function after 2 to 3 months, surgical exploration is required. During the observation period, the wrist joint is placed in the functional position, and a movable support that can pull the fingers straight is used. The joints of the injured fingers are moved by themselves to prevent deformity or stiffness. Vascular injury is not uncommon among complications of humeral shaft fractures. Generally, brachial artery injury will not cause limb necrosis but may also cause insufficient blood supply, so surgical repair of the blood vessels should still be performed.