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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