External Fixation of the Humerus


- Mid-Shaft Humeral Fractures:
    - consider screw placement in the short frx segment first, since the longer fragment will be more forgiving for shorter or longer screw 
          placement;
          - take care to avoid injury to axillary nerve proximally and the radial nerve distally;
    - proximal pin placement:
          - majority of neurvascular structures are located medially;
          - pins are placed thru anteriolateral fibers of the deltoid;
          - take care to avoid injury to axillary nerve proximally;
    - mid-shaft:
          - pins need to be placed anterolaterally to avoid the radial nerve;
          - consider making a large enough incision inorder to visualize the radial nerve (and the pin can then be placed either in front of or 
                 behind the radial nerve - depending on which is easier);
          - once the radial nerve has been identified, more distal pins can be inserted without seeing the radial nerve;
    - distal pin placement:
          - avoid injury to radial nerve by using open surgical technique (especially for pins placed more than 4 cm from epicondyle);
          - first pin is placed into lateral epicondyle (in a posterior oblique direction), w/ care to avoid insertion into olecranon fossa;
          - pins placed proximal to the epicondyles are inserted in a medial oblique direction (anterior to the radial nerve);

- Distal Third Fractures: (Holestein Lewis)
    - 3-4 pins (4 mm half pins) are placed posterior thru the triceps;
    - in distal fractures, a transfixation pin may be necessary;
          - pins are inserted from medial to lateral, the ulnar nerve is palpated, and the elbow is flexed to 60 deg in order to avoid injury to the 
                 ulnar nerve;
          - pins should be inserted parallel to the joint line



External fixation of high-energy upper extremity injuries.

Transcutaneous reduction and external fixation of displaced fractures of the proximal humerus. A controlled clinical trial.

External fixation of proximal humerus fracture. Clinical and cadaver study of pinning technique.

External fixation of displaced fractures of the proximal humerus. Technique and preliminary results.

External fixation in the upper extremity.

Management of Concomitant Ipsilateral Fractures of the Humerus and Forearm.

Gunshot Fractures of the Humeral Shaft Treated with External Fixation.


External fixation of the fracture of the humerus: a review of 164 cases.

The role of external fixation in the treatment of humeral shaft fractures: A retrospective case study review on 85 humeral fractures.

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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, December 29, 2014 4:14 pm