Orthopedic Surgery Expert Opines on Malunion Stemming From Humerus Injury

I routinely treat patients with fractures similar to this patient’s injury. These fractures are most commonly sustained in conjunction with a fall. Indications for operative repair of a humerus fracture must take into consideration the patient, the fracture itself, and surgeon-specific variables. Fracture issues include fracture reduction, adequate stability, fracture healing, and joint mobility. Patient issues include bone quality, general health/comorbidities, and functional demand/occupational requirements. Surgeon-specific variables include surgical skill and available equipment.

Complex humeral shaft fractures are classified by the Müller AO classification system as either simple, wedge, or complex fracture patterns. The description noted appears to be a complex pattern with either a spiral, segmental or irregular fragment composition. Operative stabilization would be indicated for an open fracture, in a patient unable to sit or stand, for irreducible displacement, obesity, or nerve injury. Delayed surgery is always possible. External fixation is usually indicated for unstable fractures as temporizing fixation or for loss of reduction. Closed reduction with nailing (intramedullary antegrade or retrograde) is indicated for unacceptable reduction, loss of reduction and failure to heal to name a few. Open or closed reduction with plating (plate and screws) is indicated for open fractures, unacceptable reduction, failure of fracture healing, vascular injury, radial nerve palsy, ipsilateral brachial plexus injury, obesity or large breast, and a requirement for early load bearing.