1. Introduction

a. Posterior Skin Incision

b. Dissection Lateral to Triceps Muscle

c. Identify Proximal and Distal Fragments

d. Debride Fracture

2. Exposure

a. Clamp Humerus Out to Length

b. X-Ray Confirmation

c. Dissect Triceps from Distal Fragment

d. Select Plate

3. Reduction

a. Drill Across Fracture

b. Countersink

c. Measure Screw Length

d. Insert Screw

e. Repeat for 2nd Screw

4. Lag Screws

a. Position Plate

c. Contour Plate

d. Provisional K-Wire Fixation

e. Drill, Measure, and Insert Screws

f. Final X-Rays and Radial Nerve Review

5. Plate Fixation

6. Closure

7. Post-op Remarks

Periprosthetic humeral shaft fractures are increasing in incidence as shoulder replacements become more common. Surgical management of humeral shaft fractures can only be deemed appropriate when the degree of pain, the extent of disability, and the number of comorbid conditions are taken into consideration. Among trauma surgeons there exists no preferred surgical approach to fractures of different segments of the humerus; however, the anterolateral approach to midshaft fractures is the most common although viable alternative approaches exist. In this case, we perform an open reduction and internal fixation of a diaphyseal periprosthetic humeral fracture with a posterior triceps sparing approach. 

Watch this full-length, narrated surgical video of an ORIF of a diaphyseal periprosthetic humeral fracture performed by Dr. Weaver at Brigham and Women's Hospital.

Brigham and Women's Hospital