Trauma · Shoulder & upper arm

Humeral shaft ORIF

Plate-and-screw or intramedullary nail fixation of a humerus shaft fracture for patients who can't be reliably treated in a brace.

Overview

Shoulder joint anatomy showing the humeral head, glenoid socket, and rotator cuff muscles (supraspinatus and infraspinatus).
Shoulder anatomy. The shoulder is a shallow ball-and-socket joint. The top of the upper-arm bone (humerus) sits against a small dish on the shoulder blade (glenoid), and four rotator-cuff tendons wrap around the ball to hold it centered during every arm motion.
Wikimedia Commons · CC BY-SA 4.0

The humerus shaft is the long bone between the shoulder and elbow. Many shaft fractures heal well in a functional brace without surgery, relying on gravity and progressive motion to align the bone. Surgery is reserved for fractures that won't align in a brace, for patients who cannot tolerate the bracing protocol, and for specific patterns or associated injuries.

The most common surgical indications are open fractures, pathologic fractures, vascular injury, segmental patterns, floating elbow or shoulder, polytrauma, and bilateral humerus fractures.

Why it's done

Humeral shaft ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Open fracture or vascular injury

    Urgent stabilization and soft-tissue care are required.

  2. Fracture that cannot be aligned in a brace

    Unacceptable angulation or persistent distraction.

  3. Associated injuries limiting bracing

    Floating elbow, polytrauma, or an injured contralateral arm.

  4. Radial nerve palsy with entrapment

    Exploration and fixation are sometimes indicated.

  5. Pathologic fracture

    Fixation provides pain control and limb function.

How it works

Plate fixation is performed through an anterolateral or posterior approach, depending on fracture location. The radial nerve is carefully identified and protected. A broad compression plate is applied with multiple screws on each side of the fracture.

Intramedullary nailing is an alternative, particularly for more proximal patterns, and is placed antegrade through the shoulder under fluoroscopic guidance.

Recovery

The arm is supported in a sling with early elbow and shoulder range-of-motion exercises. Active motion progresses as pain and stability allow. Bony union is typically seen at three to four months. Radial nerve symptoms can persist for several months after surgery and are usually monitored rather than re-explored unless specific findings warrant. Hardware is left unless it causes problems.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: