Non operative treatment of fracture of humerus produces very good results but not a feasible choice in many situations.
In following situations, an operative intervention needs to be considered.
Inability to maintain fracture alignment with functional bracing
In many cases, it is not possible to maintain alignment with closed methods. Poor soft tissue strength, comminuted fractures, obesity percluding molding of the cast are some situations. Sometimes the patient refuse to accept closed treatment because of the discomfort attached.
If there is an angulation of 15 degrees in any plane, surgical treatment may be considered.
Multiple injuries
A patient of polytrauma ( More than one organ system involved in trauma e.g. bone injuries with abdominal and chest injuries is a candidate for surgical intervention.
A patient with fracture humerus and spinal cord injury can be considered for operative procedure.
Multiple long bones fractures, concomitant lower extremity fractures or injuries requiring prolonged recumbency would require surgical fixation.
A floating elbow i.e. ipsilateral [involving same side] humerus and radius & ulna fractures must be treated with surgery. Bilateral humeral fractures would also need surgery.
Pathologic fracture
Pathological fractures needs to be operated in most of cases. Most of the time that also give an opportunity to get tissue for confirmation of the diagnosis.
Vascular Injury
Brachial artery can be injured along with fracture humerus. Because it is a limb threatening situation, surgical exploration is mostly required. It is wise to fix the fracture to avoid further possible injury to the vessel.
Open Fractures/ Segmental fractures
An open fracture is the one in which wound commuincates with fracture hematoma. An open fracture is generally a contaminated fracture and requires debridement and external or internal fixation of the fracture.
Segmental fracture means humerus has broken at two places and has resulted in a segment between two fractures.
Such fractures are not amenable to closed fracture treatment especially when displaced and require surgical fixation
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