Humerus Shaft Fracture Fixation

Humerus shaft fracture fixation refers to a surgical procedure to repair a fracture in the shaft (the long, straight part) of the humerus, which is the upper arm bone. This type of fracture is characterised by a break anywhere between the region just below the ball of the shoulder joint and just above the elbow joint.

The procedure is typically recommended when the fracture is complex, displaced (where the bone pieces are not aligned), or in situations where non-surgical treatments (such as casting or bracing) are deemed unsuitable or ineffective.

The decision to proceed with humerus shaft fracture fixation is based on several factors:

• Displacement of the Fracture
  If the bone fragments are misaligned (displaced), surgery may be needed to realign them properly. Non-displaced fractures, where the bone pieces remain aligned, might be treated without surgery.
• Multiple Fractures
  When there are multiple breaks along the humerus shaft, stabilising these fractures often requires surgical fixation.
• Open Fractures
  If the fracture is open, meaning the bone has pierced the skin, surgery is usually necessary to reduce the risk of infection and properly align the bone.
• Non-Union or Malunion
  In some cases, a fracture might not heal correctly (non-union) or might heal in a misaligned position (malunion). Surgery may be required to correct these issues.
• Patient Factors
  Age, overall health, activity level, and the presence of other medical conditions can influence the decision to opt for surgical fixation. For example, younger, more active individuals may benefit from surgery to ensure a quicker and more complete recovery.
• Associated Injuries
  If there are other injuries to the arm, such as damage to nerves or blood vessels, surgical fixation might be necessary as part of a comprehensive treatment plan. The radial nerve can be injured from the fracture and lead to a wrist or finger drop, which takes time to recover.

During a humerus shaft fracture fixation surgery, the following steps are typically involved:

• Anaesthesia: The procedure usually begins with the administration of general anaesthesia, rendering the patient unconscious and pain-free during the surgery.
• Incision and Exposure: The orthopaedic surgeon makes an incision over the site of the fracture to access the broken bone. The size and location of the incision depend on the fracture’s location and complexity.
• Fracture Reduction: The orthopaedic surgeon aligns the bone fragments in their proper position. This step is crucial for ensuring a good outcome and proper healing of the bone.
• Fixation: Once the bone fragments are properly aligned, they are secured in place using surgical hardware. This may include metal plates and screws, rods, or nails. The choice of hardware depends on the fracture’s nature and the orthopaedic surgeon’s preference.
• Closure: After the fixation is complete, the incision is closed with sutures or staples. In some cases, a drain may be placed to remove excess fluids from the surgical site.
• Postoperative Imaging: X-rays or other imaging techniques are often used post-surgery to confirm the correct alignment of the bone and the proper placement of the hardware.

After humerus shaft fracture fixation surgery, the focus shifts to recovery and rehabilitation, which are crucial for regaining the full function of the arm. Key aspects of postoperative care include:

• Pain Management
  Pain and discomfort are common after surgery. The orthopaedic surgeon will provide pain relief medications and guidance on how to manage pain effectively at home.
• Wound Care
  Keeping the surgical site clean and dry prevents infection. The patient will receive instructions on how to care for their wound, including when to change dressings.
• Physical Therapy
  Physical therapy usually starts soon after surgery. It helps to restore movement, strength, and function to the affected arm.
• Activity Restrictions
  Patients are typically advised to limit certain activities, especially those that may put a strain on the healing bone. Gradual reintroduction of regular activities is based on the healing process and the orthopaedic surgeon’s recommendations.
• Follow-Up Appointments
  Regular follow-up appointments are necessary to monitor the healing process. During these visits, the orthopaedic surgeon will check the surgical site, assess pain levels, and review any new X-rays to ensure the bone is healing correctly.
• Signs of Complications
  Patients should be aware of signs that may indicate complications, such as increased pain, redness, swelling, fever, or drainage from the incision site, and should contact their orthopaedic surgeon if these occur.