- See:
EBI Fixator - Insertion Technique
- 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 inorder 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.
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 ³ of pinning technique.
External fixation of displaced fractures of the proximal humerus. Technique and preliminary results.
External fixation in the upper extremity. [Review]
Management of Concomitant Ipsilateral Fractures of the Humerus and Forearm.
Rogers JF, Bennet JB, Tullos HS;
JBJS 66-A 552-556, 1984.
Gunshot Fractures of the Humeral Shaft Treated with External Fixation.
TF Wisniewski and MJ Radziejowski.
J. Orthop. Trauma. 1996. Vol 10. No 4. p 273-278.
External fixation of the fracture of the humerus: a review of 164 cases.
M Hinsenkamp et al.
Orthopaedics. Vol 7. 1309-1314. 1984.
