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18 Mar 2024
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Diaphyseal Humerus Fracture with Third Butterfly Wing Fragment: Plate Osteosynthesis

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Clinical Details

Clinical and radiological findings:  A young male patient, after suffering a direct trauma to the right arm, presented a humerus diaphyseal fracture with a third butterfly wing fragment. No injury to the radial nerve is reported. Radiological evaluation confirmed the presence of the fracture without other associated injuries.

Preoperative Plan

Planning remarks:  A posterior surgical approach is planned, with the intention of performing osteosynthesis by placing a plate. Exploration of the radial nerve is considered to prevent damage during the procedure. Fixation of the butterfly wing fragment is planned through the use of sutured cerclage.

Surgical Discussion

Patient positioning:  The patient is positioned in a prone position, with the right arm extended and slightly elevated to facilitate posterior access.

Anatomical surgical approach:  A posterior approach is performed through the intermuscular septum. It begins with a longitudinal incision centered on the axis of the humerus. The soft tissues are carefully dissected, preserving the radial nerve through its exploration and active protection during the approach and osteosynthesis.

Operative remarks: 

During the intervention, the presence of a third butterfly wing fragment is confirmed. Osteosynthesis is performed using a 4.5mm LCDCP posterior plate, secured with screws. For specific fixation of the butterfly wing fragment, a cerclage with suture is used, using Nice knots to ensure adequate stabilization.

Postoperative protocol:   Postoperative immobilization with a sling is indicated during the first weeks, followed by early passive mobilization to avoid joint stiffness. Loading and active mobilization will be increased progressively according to tolerance and evidence of bone consolidation.

Follow up:   No especificado.

Orthopaedic implants used:   4.5mm LCDCP posterior plate, osteosynthesis screws, cerclage with Nice suture.

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LUIS LEONCIO TEMOCHE DIAZ
  • Peru , Lima
  • Area of Specialty - Shoulder
  • Position - Specialist Consultant
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