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Long Bone Fracture Repair

Fractures of the long bones of the upper extremity (humerus, radius, and ulna) are quite common. They occur in roughly .049% of the population, often in trauma settings such as falls, motor vehicle accidents, etc. They are particularly common in the young and in the aging population. This, in turn, makes long bone fracture repair a fairly common procedure.

The humerus is the largest and longest bone of the upper extremity.  The humerus articulates in its upper end with the scapula. This comprises the shoulder joint and, where it meets the bones of the forearm, the elbow joint as well.  In between these joints, the humerus is a long tubular bone, or diaphysis.

One important structure closely associated with this long bone is the radial nerve.  The nerve wraps around the bone in a spiral direction along its corresponding radial groove.  The radial nerve gives innervation to the wrist and finger extensor muscles. Injury to it leads to significant motor dysfunction.  There are multiple tendon insertions and muscular attachments along the bone that make its anatomy rather complex.

The radius and the ulna are the two long bones of the forearm.

Fractures about the long portion of the humerus can be extremely difficult to address successfully.  One source of concern is radial nerve damage, either at the time of presentation or in the course of treatment.  To date, many surgeons shy away from treating these fractures because of the risks associated. These include radial nerve injury, fracture healing failure, and malunion or abnormal healing, among others.

Historically, fracture braces played an important role in the treatment of such shaft injuries.  However, their popularity has deteriorated due to the unpredictable process of fracture healing in a brace.

Long Bone Fracture Repair Today

Today, a large number of long bone fractures are treated surgically.  Realigning and stabilizing the fracture sufficiently via ORIF (Open Reduction Internal Fixation) is the goal. This will minimize pain, return function and promote rehabilitation.

Most displaced fractures of the forearm long bones require surgical treatment.  Many believe the best modality to achieve rigid fixation of these bones is plating.

Most surgeons today use long plates and screws to stabilize upper extremity long bone fracture fragments.  Some surgeons prefer a minimally invasive approach and use intramedullary nails or rods that fit into the hollow inside of the bone.  Though a minimally invasive process, intramedullary nailing can sometimes lead to more damage, both to the muscles around the shoulder during the nail insertion and to the radial nerve. This is because the nerve is not visualized as the nail is advanced across the fracture site during the procedure.

External fixation is a less popular, though sometimes used, method, which includes external frames that are connected to the bone through pins that traverse the skin.

The WOLF® system differs from other long plates on the market today, which tend to be thick and rigid when compared with the dimensions of the bones. Further, where other long locking plates can only place screws one way (perpendicular to the plate which, frequently, may not be the desired direction for the screw placement), TOBY’s WOLF® technology allows for the placement of two divergent screws per hole.  This allows the surgeon to pick the optimum placement.

Long Bone Fracture Repair: A Conversation For You And Your Doctor

Only your doctor can advise you on your specific needs.  However, if you have weak or osteoporotic bone, or if you have a complicated injury, the WOLF® system can allow your surgeon the option of using pegs, rather than screws, which remove less of the bone.  The A-frame design, constructed by the dual-divergent nature of the fasteners into the plate, provides unparalleled strength of fixation.

Therefore, we encourage you to speak with your doctor about all options you feel might be right for you.