
Approaches and
Positioning
The
approaches for plating in the humeral shaft can be either anterolateral or dorsal. The proximal trains deltoid and the distal dorsal approaches are followed for nailing. The
patient is positioned supine or semi-seated with the chest elevated about
30°for the antegrade approach. But for the dorsal approach. The patient is made
to lie on the table with the fractured side close to its edge and the head
facing away. The fractured upper armrests on a radiolucent side table with the
forearm hanging down.
Transdeltoid approach
This approach is applied for .
Anterolateral
approach
An anterolateral approach may be used for the plating of proximal humeral
shaft fractures. This may be extended down the shaft for middle-third
fractures. One needs to be careful while using this approach in distal-third
fractures as the radial nerve cling to the lateral cortex and may be trapped below
the distal corner of the plate.
Dorsal
approach
This approach is commonly used for the distal half fractures of the
humerus. Once the radial nerve is identified, it can be easily extended for
more proximal fractures. Access for nailing needs approximately 8 cm. incision
in over the distal part.
Reduction tools and techniques
In order to restore length, the reduction is
achieved by careful traction which is afterward maintained with pointed
reduction forceps in a spiral or oblique fractures. Reduction for plating must be
atraumatic. Transverse fractures can be reduced properly by using the plate.
The plate is positioned extraperiosteally.
The reduction is done with the nail partially
inserted in case of closed nailing. Then, it is used as a reduction tool, the
opposing fragment is taken up and engaged. Additional external manipulation
will facilitate the process. The usual tools can be applied for open reduction.
Implant Selection
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Author Signature :
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