M.E.Müller: Atlas: Fracture 12-B1

Humerus, Diaphysis,
wedge fracture, spiral wedge 0,22% of the total
3,11% of the humerus
14,08% of the segment

21 fractures 17,2% group 38%M, 62%F

41 fractures
33,6% group
51%M, 49%F

60 fractures 49,2% group
52%M, 48%F

Proximal section Middle section Distal section

These are fractures with a spiral wedge third fragment, located at the proximal or at the middle third of the humeral diaphysis. Once reduced, there is contact between the proximal and distal fragments. Ref. Manual of Internal Fixation:
232 - 251. 442 - 445.
Surgeon. RO, JM, LO.

The proximal fractures may extend up to the level of the humeral neck, requiring some method of internal fixation that holds on to the humeral head. The classic implant is the T-plate but, whenever possible, we prefer to use a plate cut and contoured to form a hook (see A2.1) so as not to interfere with the path-way of the bicipital tendon.

The middle third fractures usually heal with conservative treatment. However, when faced with a delayed union, it is preferable to proceed before long to internal fixation

with a plate that will guarantee a fast healing and an early functional recovery.

The two illustrated cases treated with internal fixation demonstrate how, with a good interfragmentary compression by screws through the plate, it is not necessary to use the big femoral plates and a thinner implant will suffice. The other case shows an excellent result of conservative treatment.

preoperative + 8 months

preoperative + 1 year

+ 4 months + 1 year

preoperative preoperative + 0 months + 4 months

+ 9 months + 9 months

These are fractures with a spiral wedge third fragment, located at the distal third of the humeral diaphysis. Once reduced, there is contact between the proximal and distal fragments. Ref. Manual of Internal Fixation:
232 - 251. 442 - 445.
Surgeon. RO, RO.

Since they have a broad fracture surface, healing time will be short. However, their location at the segment .3 (distal) means that they will usually require anatomic reduction and stable internal fixation. It is essential to follow the principles of interfragmentary compression with lag screws (preferably through the plate) and to neutralize the fracture site with a plate of a size proportionate to that of the bone. The plate must be contoured for proper adaptation to the distal flare of the diaphysis, as explained for the A1.3 subgroup. In this segment, the cortices are quite hard and the screws will have an excellent hold.

In the case illustrated in the superior half of the page, the interfragmentary compression was performed with lag screws through the plate. In the other case, interfragmentary compres-sion was performed with independent screws (4.5 mm) while the fracture site was neutralized with a one-third tubular plate with 3.5 mm screws (sufficient because of the size of the bone).

All of the measures to protect the radial nerve, common to any surgery of the humerus, must be observed. One of the advantages of the titanium plates is that there is no need to remove them, because of their tolerance, thus avoiding a second surgical procedure through fibrous tissue, a great risk for the radial nerve.

preoperative +1 year +1 year

preoperative +1 year +1 year




						Humerus, Diaphysis, wedge fracture, spiral wedge	0,22% of the total 3,11% of the humerus 14,08% of the segment






These are fractures with a spiral wedge third fragment, located at the proximal or at the middle third of the humeral diaphysis. Once reduced, there is contact between the proximal and distal fragments.		Ref. Manual of Internal Fixation: 232 - 251. 442 - 445. Surgeon. RO, JM, LO.

The proximal fractures may extend up to the level of the humeral neck, requiring some method of internal fixation that holds on to the humeral head. The classic implant is the T-plate but, whenever possible, we prefer to use a plate cut and contoured to form a hook (see A2.1) so as not to interfere with the path-way of the bicipital tendon. The middle third fractures usually heal with conservative treatment. However, when faced with a delayed union, it is preferable to proceed before long to internal fixation	with a plate that will guarantee a fast healing and an early functional recovery. The two illustrated cases treated with internal fixation demonstrate how, with a good interfragmentary compression by screws through the plate, it is not necessary to use the big femoral plates and a thinner implant will suffice. The other case shows an excellent result of conservative treatment.






These are fractures with a spiral wedge third fragment, located at the distal third of the humeral diaphysis. Once reduced, there is contact between the proximal and distal fragments.		Ref. Manual of Internal Fixation: 232 - 251. 442 - 445. Surgeon. RO, RO.

Since they have a broad fracture surface, healing time will be short. However, their location at the segment .3 (distal) means that they will usually require anatomic reduction and stable internal fixation. It is essential to follow the principles of interfragmentary compression with lag screws (preferably through the plate) and to neutralize the fracture site with a plate of a size proportionate to that of the bone. The plate must be contoured for proper adaptation to the distal flare of the diaphysis, as explained for the A1.3 subgroup. In this segment, the cortices are quite hard and the screws will have an excellent hold.	In the case illustrated in the superior half of the page, the interfragmentary compression was performed with lag screws through the plate. In the other case, interfragmentary compres-sion was performed with independent screws (4.5 mm) while the fracture site was neutralized with a one-third tubular plate with 3.5 mm screws (sufficient because of the size of the bone). All of the measures to protect the radial nerve, common to any surgery of the humerus, must be observed. One of the advantages of the titanium plates is that there is no need to remove them, because of their tolerance, thus avoiding a second surgical procedure through fibrous tissue, a great risk for the radial nerve.