M.E.Müller: Atlas: Fracture 12-B2

Humerus, Diaphysis,
wedge fracture,
bending wedge 0,21% of the total
2,96% of the humerus
13,40% of the segment

7 fractures 6% group 43% 43%M, 57% F

76 fractures
65,5% group
69%M, 31%F

33 fractures 28,5% group
63%M, 37%F

Proximal section Middle section Distal section

These are diaphyseal fractures of the humerus with a bending wedge third fragment, usually a short wedge and associated to a small fragment. Once reduced, there is contact between the proximal and distal fragments. Ref. Manual of Internal Fixation:
232 - 251. 442 - 445.
Surgeon. LO.

These fractures are quite unstable because of their short fracture lines in a small segment. Conservative treatment or Hackethal´s intramedullary nailing may be tried but the results are uncertain. In young patients, manual workers and sportsmen, we believe that it is more effective to secure the internal fixation with a straight plate, following the principles stated for the types A and B, with some added technical considerations.

The wedge must be anatomically reduced and fixed to at least one of the large fragments with a 3.5 mm. lag screw in order for it to participate in the solidity of the assembly at the time of axial compression. Autologous cancellous bone graft must be added because, generally, the third fragment is completely avascular.

The ideal implant is the titanium LC-DCP plate, of a size proportionate to that of the bone, placed in the aspect of the diaphysis that will be less likely to interfere with the blood supply of the wedge, that is to say, on the side opposite to the largest cortical surface of the wedge. We use few LC-DCP plates in fractures of other locations of the skeleton because of their cost. However, for the fractures of the humeral diaphysis we think that it is cost effective because of the advantage of being almost sure that the plate will not have to be removed. The removal of a plate in the territory of the radial nerve always carries great risk.

preoperative postoperative postoperative

+4 months +4 months +2 years +2 years

preoperative preoperative

+4 months +4 months +8 months
+8 months




						Humerus, Diaphysis, wedge fracture, bending wedge	0,21% of the total 2,96% of the humerus 13,40% of the segment






These are diaphyseal fractures of the humerus with a bending wedge third fragment, usually a short wedge and associated to a small fragment. Once reduced, there is contact between the proximal and distal fragments.		Ref. Manual of Internal Fixation: 232 - 251. 442 - 445. Surgeon. LO.

These fractures are quite unstable because of their short fracture lines in a small segment. Conservative treatment or Hackethal´s intramedullary nailing may be tried but the results are uncertain. In young patients, manual workers and sportsmen, we believe that it is more effective to secure the internal fixation with a straight plate, following the principles stated for the types A and B, with some added technical considerations. The wedge must be anatomically reduced and fixed to at least one of the large fragments with a 3.5 mm. lag screw in order for it to participate in the solidity of the assembly at the time of axial compression. Autologous cancellous bone graft must be added because, generally, the third fragment is completely avascular.	The ideal implant is the titanium LC-DCP plate, of a size proportionate to that of the bone, placed in the aspect of the diaphysis that will be less likely to interfere with the blood supply of the wedge, that is to say, on the side opposite to the largest cortical surface of the wedge. We use few LC-DCP plates in fractures of other locations of the skeleton because of their cost. However, for the fractures of the humeral diaphysis we think that it is cost effective because of the advantage of being almost sure that the plate will not have to be removed. The removal of a plate in the territory of the radial nerve always carries great risk.