Manual reduction, external fixation

1.anesthesia: topical anesthesia or brachial plexus nerve block.

2. position: supine position on orthopedic traction bed.

3. traction: hold the forearm with elbow flexion 90 degree, If the fracture is located above the deltoid muscle check point and under the pectoralis major check point, the close traction can be applied. If the fracture is located under the deltoid check point, the outside traction can be applied.

4. restoration: after fully continuous traction and muscle is relaxed, hold the fracture end by two hands, Correct angulation and according to the fracture displacement in the opposite direction. Patient should accept X-ray films to confirm the fracture counterpoint circumstance.

5. external fixation: after restoration, reduce the traction, maintain the restoration, can choose splint or plaster to fix.

(1)fixed by splint: fixed by 4 splint with suitable length at 4 direction around arm.

(2)fixed by plaster: fixed by U plaster if the fracture is stable after restoration. Light plaster can be used and in a fixed period fracture counterpoint situation should be closely observed in fixing period.
 

Reduction, internal fixation

1.If the indications of operation is in following circumstance, reduction and internal fixation can be applied:

(1)  manual reduction is failed and Fracture position on the line is bad, which will affect the function after healing.

(2)  Displaced separation of the fracture takes place.

(3)  Combined with neurovascular injury.

(4)  Old nonunion.

(5)  Malunion which affects the function.

(6)  Same limb with multiple fractures.

(7)  Within 8 to 12 hours of open fractures which is not heavy polluted.
 

2. Surgical methods

(1)Anesthesia: brachial plexus anesthesia or epidural anesthesia.

(2) Position: supine, the injured limb abduction 90 ° on the operating table.

(3) Incision and exposure: cut between the biceps and triceps tendon, expose the muscle gap along the fracture. If it is a up 1/3 fracture, up neck incision deltoid, biceps extend gap. If it is a down 1/3 fracture, gap down biceps, brachioradialis extend gap. Be careful not to damage the radial nerve.

(4)Reduction and fixation: try to arrive at the anatomic alignment Under direct vision. Internally fix by screw compression plate or externally fix, Also available in interlocking intramedullary nail fixation. External fixation is not necessary after surgery, early functional exercise is proposed. 1/3 humeral shaft fracture bone destruction heavier blood circulation. It is easily lead to nonunion coupled with the surgical procedure. In recent years, it is popular to apply limited contact plate fixation which is conducive to bone healing due to reducing the impact on the blood supply. For patients with radial nerve injury, explore nerve intraoperatively, if it is completely broken, a restoration of the radial nerve is necessary.

 

Whether manual reduction and external fixation, internal fixation or cut, postoperative rehabilitation should be early.

1. Reset after raising arm, actively exercises fingers  by range of motion. 

2. After 2 to 3 weeks, start activities of the initiative of the wrist, elbow and shoulder with range of motion of abduction. But activity should not be too large. Gradually increase activity levels and frequency of activities.

3. Increase activity after 6 to 8 weeks, and activities for shoulder rotation.

4. During a workout, keeps checking the fracture on-line alignment and healing circumstance.

5. Except for the fixation after fracture heals completely. Internal fixation can be removed after six months. If there is no discomfort, removing may not be necessarily.

6. During the workout, can be used with physical therapy, physical therapy, Chinese medicine, Chinese medicine treatment.