CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

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SURGICAL MANAGEMENT OF HUMERUS FRACTURES: TECHNIQUES, INDICATIONS, AND OUTCOMES

Ahmet Ersoy1 Tolgahan Cengiz2 Ferhat Say3

1Tokat Turhal State Hospital, Department of Orthopedics and Traumatology, Tokat, Türkiye
2Kastamonu İnebolu State Hospital, Department of Orthopedics and Traumatology, Kastamonu, Türkiye
3Samsun Ondokuz Mayıs University, Faculty of Medicine, Department of Orthopedics and Traumatology, Samsun, Türkiye

Ersoy A, Cengiz T, Say F. Surgical Management of Humerus Fractures: Techniques, Indications, and Outcomes. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.97-103.

ABSTRACT

Humerus fractures, affecting the upper arm bone, vary in complexity based on fracture location, severity, and patient health. Surgical intervention is often necessary for displaced, comminuted, or joint-involved fractures to ensure anatomical alignment, stable fixation, and early mobilization. This chapter outlines various surgical techniques for managing humerus fractures, including the deltopectoral and anterolateral approaches for proximal fractures, posterior and anterolateral approaches for humeral shaft fractures, and posterior and column-based approaches for distal humerus fractures. Techniques such as Open Reduction and Internal Fixation (ORIF), Intramedullary Nailing (IMN), and Total Shoulder or Elbow Arthroplasty are discussed alongside their respective advantages and disadvantages. Complications, including nerve injury, infection, and non-union, are addressed, with prevention strategies highlighted. Postoperative care, emphasizing early mobilization and rehabilitation, plays a critical role in successful outcomes. This comprehensive guide assists surgeons in making informed decisions regarding humerus fracture management, ensuring optimal patient recovery and functional restoration.

Keywords: Humerus fractures; Surgical management; Management; Anatomy; Internal fixation; Nonoperative

Referanslar

  1. Klenerman L. Fractures of the shaft of the humerus J Bone Joint Surg Br. 1966:48(1):105-11. [Crossref]
  2. Zlotolow DA, et al. Surgical exposures of the humerus. J Am Acad Orthop Surg. 2006;14(13):754-65. [Crossref]  [PubMed]
  3. Graftiaux A, Charles M, Court-Brown, James D, Heckman, Margaret M, Mc Queen, William M Ricci, Paul Tornetta III Ersoy, Cengiz, Say Surgical Management of Humerus Fractures: Techniques, Indications, and Outcomes (eds). Rockwood and Green's Fractures in adults eighth edition. Eur J Orthop Surg Traumatol. 2015;25:1229. [Crossref]
  4. Fakler JK, et al. Current concepts in the treatment of proximal humeral fractures. Orthopedics. 2008;31(1):42-51. [Crossref]  [PubMed]
  5. Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults-A Scoping Review. J Clin Med. 2022;11(20):6140. [Crossref]  [PubMed]  [PMC]
  6. Feist M. et al, [Long bone fractures in cattle: A retrospective study of treatment and outcome in 194 cases]. Schweiz Arch Tierheilkd. 2019;161(9):509-521. [Crossref]  [PubMed]
  7. Balfour GW, Mooney V, Ashby ME. Diaphyseal fractures of the humerus treated with a ready-made fracture brace. J Bone Joint Surg Am. 1982;64(1):11-3. [Crossref]  [PubMed]
  8. Updegrove GF, Mourad W, Abboud JA. Humeral shaft fractures. J Shoulder Elbow Surg. 2018;27(4): e87-e97. [Crossref]
  9. Carroll EA, et al. Management of humeral shaft fractures. J Am Acad Orthop Surg. 2012;20(7):423-33. [Crossref]  [PubMed]
  10. Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am. 1996;78(11):1690-5. [Crossref]  [PubMed]
  11. Iselin LD, et al. The triceps reflecting approach (Bryan-Mor rey) for distal humerus fracture osteosynthesis. BMC Musculoskelet Disord. 2014;15:406. [Crossref]  [PMC]
  12. Jawa A, et al. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am. 2006;88(11):2343-7. [Crossref]  [PubMed]
  13. Gausden EB, et al. The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications. Arch Orthop Trauma Surg. 2016;136(12):1683-1689. [Crossref]  [PubMed]
  14. Teng. L, et al. Combined Medial and Lateral Approach Versus Paratricipital Approach in Open Reduction and Internal Fixation for Type C Distal Humerus Fracture: A Randomized Controlled Study. Orthop Surg. 2023;15(8):2062-2073. [Crossref]  [PubMed]  [PMC]
  15. Mighell MA, et al. Distal Humerus Fractures: Open Reduction Internal Fixation. Hand Clin. 2015;31(4):591-604. [Crossref]  [PubMed]
  16. Daly M. Langhammer C. Radial Nerve Injury in Humeral Shaft Fracture. Orthop Clin North Am. 2022;53(2):145-154. [Crossref]  [PubMed]
  17. Li M, et al. Risk factors for surgical site infection after closed proximal humerus fractures. Int Wound J. 2024;21(3): e14515. [Crossref]  [PMC]
  18. Cho E, et al. Complications and functional outcomes after transolecranon distal humerus fracture. J Shoulder Elbow Surg. 2021;30(3):479-486. [Crossref]