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Orthopaedics
Humerus
Built from Orthopedic Trauma Essentials
What’s inside
5 sections · 123 slides
Overview
- The arm bone that breaks at both ends
- Three fracture zones, three different problems
- Landmarks on the bone you must know
Proximal humerus fractures
Operate or not, plate or nail, fix or replace
- Surgery has not won this argument
- PROFHER: surgery gave nothing extra
- What the pooled reviews add
- Two-part fractures in the over-60s
- So when is leaving it alone right?
- When surgery is clearly indicated
- The young, active patient
- CT of a fractured humeral head
- What to notice on that scan
- How plate fixation fails here
- Why the construct gives way
- Fixing the calcar fixes a lot
- Ways to boost a weak construct
- What augmentation actually buys you
- Bone graft or cement?
- Fibular allograft: the evidence splits
- What internal fixation is trying to achieve
- Locking plate on the proximal humerus
- Nail or plate: the two surgical routes
- Why a nail can be the stiffer construct
- Head to head in two-part fractures
- Multilock nail versus cemented plate
- Three- and four-part fractures in the elderly
- When to reach for a plate
- When to reach for a nail
- Modern nails fixed the old problems
- The rule that outranks the implant
- Fix it or replace it?
- What tips fixation towards failure
- Unpacking those risk factors
- Hertel's predictors of a starved head
- But the predictors are not destiny
- DelPhi: reverse replacement beat fixation
- Fixation still buys independence
- If you replace, which replacement?
- Reverse shoulder replacement on x-ray
- Choosing fixation over replacement
- Ideal indications for arthroplasty
Humeral shaft fractures
A forgiving bone, an unforgiving nerve
- Why a crooked humerus can still work
- What pushes a shaft fracture to theatre
- Neither route is complication-free
- The classic case for the brace
- Bracing in everyday practice
- Randomised trials now lean towards surgery
- Nonunion is the recurring penalty
- FISH: early gain, late equality
- Who fails a brace? 1182 patients answer
- HUMMER: surgery recovers faster
- Where nonoperative care still fits
- Operate early when these are present
- Three ways to fix a shaft
- What those three names mean
- Approach and pattern drive the choice
- The trade-off in one line each
- MIPO matches open plating
- MIPO even in simple fractures
- Pooled data favour MIPO
- Plate versus nail, randomised
- HUMMER on plate versus nail
- Picking between the three
- Nailing: the fine print
- The nerve that hugs the bone
- Primary or secondary palsy
- How badly is the nerve hurt?
- How often, and how often it recovers
- A systematic review agrees on recovery
- The case for exploring early
- Ultrasound can settle the question
- Default: expect recovery
- When to explore instead of wait
- What early exploration gives you
- Preventing the palsy you cause
Distal humeral fractures
Getting to the joint, holding two columns, sparing a nerve
- The exposure problem at the elbow
- Keep the triceps or take it down
- What those approach names mean
- How much joint can you actually see?
- The price of cutting the olecranon
- The TRAP approach in review
- Osteotomy versus triceps reflecting
- Triceps tongue versus osteotomy
- Choosing your way in
- Two columns, two plates
- Parallel plating of a distal humerus fracture
- Interdigitating screws in a parallel construct
- Orthogonal plating of a distal humerus fracture
- What either construct must deliver
- Biomechanics favour parallel
- The interdigitating principle
- Pooled clinical outcomes
- Elderly bone punishes orthogonal
- Randomised evidence, same direction
- Where parallel wins
- Orthogonal is still a real option
- Old bone, shattered joint, weak grip
- TEA: fewer complications, faster recovery
- The pooled review in over-60s
- A small trial finds no difference
- Function equal, complications not
- Who should get a new elbow
- The ulnar nerve's exposed journey
- Four ways the nerve gets hurt
- Ulnar nerve moved in front of the elbow
- The traditional argument for moving it
- Transposition looked worse, not better
- 116 patients, no protective effect
- In situ decompression came out ahead
- 1280 patients say the same
- Leave it alone, but decompress it well
- When transposition is still right
Takeaways
What to carry away from the humerus
- Proximal humerus in five lines
- Humeral shaft in five lines
- Distal humerus in five lines
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- Orthopedic Trauma Essentials 2026