Name of the Procedure:

Closed Treatment of Humeral Shaft Fracture; with Manipulation, with or without Skeletal Traction

Summary

This procedure involves the non-surgical realignment of a fractured humeral shaft (the long bone in the upper arm between the shoulder and elbow). The treatment can include manual adjustment (manipulation) of the bone. In some cases, skeletal traction (a method where a pulling force is used to hold the broken bones in the correct position) may be applied.

Purpose

The procedure addresses fractures of the humeral shaft. The goal is to realign the bone fragments and ensure proper healing without the need for surgery. This aids in restoring arm function and minimizing complications.

Indications

• Visible deformity in the upper arm.
• Pain, swelling, or bruising following trauma to the arm.
• Inability to use or move the arm normally.
• X-ray confirmation of a humeral shaft fracture.

Preparation

• Patients may need to fast if sedation is to be used.
• Discontinuation of certain medications (e.g., blood thinners) as advised by a doctor.
• Pre-procedure evaluation, including a physical exam and imaging tests like X-rays to assess the fracture.

Procedure Description

1. Administration of anesthesia or sedation to make the patient comfortable.
2. The physician manually manipulates the arm to realign the bone fragments.
3. If needed, skeletal traction is applied using weights or pulleys to maintain bone alignment.
4. The arm is immobilized with a cast, brace, or splint to maintain the correct position during healing.
5. Follow-up X-rays are taken to ensure the bones remain properly aligned.

Duration

Typically takes 1-2 hours, including preparation and post-procedure observation.

Setting

Usually performed in a hospital emergency department or outpatient clinic.

Personnel

• Orthopedic surgeon or trained physician.
• Nurses to assist with preparation and post-procedure care.
• Anesthesiologist or sedation nurse if sedation is required.

Risks and Complications

• Pain during manipulation.
• Swelling or bruising.
• Potential for incomplete bone alignment.
• Nerve or blood vessel injury.
• Risk of needing surgical intervention if non-surgical methods fail.
• Infection if skeletal traction is used.

Benefits

• Non-surgical approach reduces the risks associated with surgery.
• Proper bone alignment facilitates optimal healing.
• Less invasive and quicker recovery compared to surgical options.
• Enables early return to normal activities.

Recovery

• Follow-up appointments to monitor healing via X-rays.
• Physical therapy may be required to restore motion and strength.
• Patients typically need to wear a cast, brace, or splint for several weeks.
• Limited arm use initially, gradually increasing activity per medical advice.

Alternatives

• Open reduction and internal fixation (surgical realignment with hardware).
  • Pros: Direct visualization and precise alignment of bone fragments.
  • Cons: Invasive, longer recovery, surgical risks.
• Functional bracing without manipulation.
  • Pros: Non-invasive, lower immediate risk.
  • Cons: May not provide as accurate alignment, potentially longer immobilization.

Patient Experience

During the procedure, patients will be under anesthesia or sedation and should not feel pain. Post-procedure, they may experience soreness and will need to keep the arm immobilized. Pain management, including medication, will be provided to ensure comfort during recovery.