Overview
The humerus shaft is the long bone between the shoulder and elbow. Many shaft fractures heal well in a functional brace without surgery, relying on gravity and progressive motion to align the bone. Surgery is reserved for fractures that will not align in a brace, for people who cannot tolerate the bracing protocol, and for specific patterns or associated injuries.
The most common reasons to operate are open fractures (the bone has broken through the skin), pathologic fractures (breaks through bone weakened by disease), injury to a blood vessel, segmental patterns (the bone is broken at more than one level), a "floating" elbow or shoulder (fractures on both sides of the joint), and fractures of both arms. Patients with multi-system injuries are coordinated through a regional trauma center.
Why it's done
ORIF stands for open reduction and internal fixation: the bone is realigned in surgery (open reduction) and held in its corrected position with hardware (internal fixation). It is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Open fracture or vascular injury
Urgent stabilization and soft-tissue care are required.
Fracture that cannot be aligned in a brace
The bone sits at an unacceptable angle, or the broken ends stay pulled apart (persistent distraction).
Associated injuries limiting bracing
A "floating" elbow, multiple major injuries, or an injured opposite arm.
Radial nerve palsy with entrapment
Exploration and fixation are sometimes indicated.
Pathologic fracture
Fixation provides pain control and limb function.
How it works
Plate fixation is done through an incision on the front-outer or the back of the arm, depending on where the bone is broken. The radial nerve, which wraps closely around the humeral shaft, is carefully identified and protected throughout. A broad compression plate is then applied with multiple screws on each side of the fracture.
The alternative is an intramedullary nail: a metal rod passed down the hollow center of the bone. It suits more proximal patterns (fractures closer to the shoulder) and is inserted from the top of the shoulder under live X-ray guidance (fluoroscopy).
Recovery
Your arm will be supported in a sling, and early elbow and shoulder range-of-motion exercises begin soon after surgery. Active motion progresses as pain and stability allow. Your surgeon confirms bone healing on X-rays at follow-up visits. Radial nerve symptoms (such as weakness in wrist or finger extension) can persist for months after surgery and are usually monitored rather than surgically re-explored unless specific findings indicate otherwise. Hardware is left in place unless it causes problems.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Humeral Shaft ORIF
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb helps new bone form. Completely resting a fixed fracture for too long can actually slow healing and stiffen the joints above and below. Full body weight right away, however, can be too much for the repair before the bone has caught up. The right answer sits in between: a partial weight-bearing plan set by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on X-rays after surgery. We tell you exactly how much weight the limb can take, when to do more, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause an arm bone that heals crooked or not at all, often with injury to the radial nerve. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
Before this surgery, we go over the following risks with you:
- bleeding and infection
- anesthesia risk
- radial nerve palsy (the nerve runs directly against the humeral shaft; most palsies recover, but not all)
- the bone failing to heal (non-union)
- hardware irritation
- stiffness of the shoulder and elbow
- blood clot (rare in upper-extremity surgery)
The indication to proceed is a displaced humeral shaft fracture that cannot be managed in a functional brace, or one with a radial nerve deficit requiring exploration. If this operation is not right for your situation, we will not recommend it.
Frequently Asked
questions we hear in clinicDoes a broken humerus always need surgery?
No. Many shaft fractures heal well in a functional brace without surgery, relying on gravity and progressive motion to align the bone. Surgery is reserved for fractures that will not align in a brace, for people who cannot tolerate the bracing protocol, and for specific patterns or associated injuries.
What does ORIF mean?
Open reduction and internal fixation: the bone is realigned in surgery (open reduction) and held in its corrected position with hardware (internal fixation).
Will I get a plate or a rod?
Plate fixation is done through an incision on the front-outer or the back of the arm, depending on where the bone is broken. The alternative is an intramedullary nail, a metal rod passed down the hollow center of the bone; it suits fractures closer to the shoulder and is inserted from the top of the shoulder under live X-ray guidance.
What about the radial nerve?
The radial nerve wraps closely around the humeral shaft, so it is carefully identified and protected throughout surgery. Radial nerve symptoms, such as weakness in wrist or finger extension, can persist for months after surgery and are usually monitored rather than surgically re-explored unless specific findings indicate otherwise. Most palsies recover, but not all.
When can I move my arm?
Your arm will be supported in a sling, and early elbow and shoulder range-of-motion exercises begin soon after surgery. Active motion progresses as pain and stability allow.
Will the hardware come out later?
Hardware is left in place unless it causes problems.
Further Reading
External patient-education references and related OSI pages for additional background: