Humeral Shaft Fractures

Front 1

What are the borders of the humeral shaft?

Back 1

The humeral shaft extends from the pectoralis major insertion to the supracondylar ridge. In this interval, the cross-sectional shape changes from cylindric to narrow in the anteroposterior direction.

Front 2

What is the blood supply of the humeral shaft?

Back 2

The vascular supply to the humeral diaphysis arises from perforating branches of the brachial artery, with the main nutrient artery entering the medial humerus distal to the midshaft.

Front 3

Which nerve is very import to evaluate in a humeral shaft fracture?

Back 3

A careful neurovascular examination is essential, with particular attention to radial nerve function.

Front 4

What initial set of X-Rays should be ordered in a suspected humeral shaft fracture?

Back 4

AP and lateral radiographs of the humerus should be obtained, including the shoulder and elbow joints on each view.

Front 5

What are the acceptable deformity parameters for non-opperative treatment of a humeral shaft fracture?

Back 5

Twenty degrees of anterior angulation, 30 degrees of varus angulation, and up to 3 cm of bayonet apposition are acceptable and will not compromise function or appearance.

Front 6

Which surgical approach is preferred for proximal third humeral shaft fractures?

Back 6

Anterolateral approach: preferred for proximal third humeral shaft fractures; radial nerve identified in the interval between the brachialis and brachioradialis and traced proximally. This can be extended proximally to the shoulder or distally to the elbow.

Front 7

Where can the radial nerve be identified in an antero-lateral approach?

Back 7

The radial nerve is identified in the interval between the brachialis and brachioradialis and traced proximally

Front 8

What nerve is at risk when an antegrade IMN technique is used?

Back 8

With antegrade nailing, the axillary nerve is at risk for injury during proximal locking screw insertion. Screws protruding beyond the medial cortex may potentially impinge on the axillary nerve during internal rotation. Anterior to posterior screws are avoided because of the potential for injury to the main trunk of the axillary nerve.

Front 9

What blood vessel is at greatest risk with a humeral shaft fracture?

Back 9

The brachial artery has the greatest risk for injury in the proximal and distal third of arm.