Published in:
01-02-2016 | Clinical Faceoff
Clinical Faceoff: Are Distal-third Diaphyseal Humerus Fractures Best Treated Nonoperatively?
Authors:
David Ring, MD, PhD, Andrew Jawa, MD, Lisa Cannada, MD
Published in:
Clinical Orthopaedics and Related Research®
|
Issue 2/2016
Login to get access
Excerpt
Distal-third diaphyseal fractures of the humerus are so variably treated that they seem to be a paradigm for bias and misconceptions in surgery. Conceptually, a functional brace seems “too low,” but the fractures almost always heal, although some fractures heal with varus deformity. The surgery is not easy because there is often a butterfly fragment—meaning that the plate must extend proximal, placing the radial nerve at risk. In order to get good fixation, one needs to extend the plate down the posterior, nonarticular part of the lateral column, which makes it difficult to use a straight plate. Consequently, the most distal screws might be unicortical, and subject to pull out in osteoportic bone. …
