Definition
Realignment and fixation of a fracture of the arm necessitating an operative incision.
Discussion
- A variety of fractures of the humerus may occur.
- If closed reduction and immobilization are unsatisfactory or when there is nounion, fixation may be achieved by using a number if internal fixation devices, including screws, rods, and compression plates.
Positioning
- Supine, affected arm in comfortable position, unaffected arm extended on an armboard.
Packs/ Drapes
- Extremity pack with fenestrated sheet
- Impervious stockinette
- Eshmarch bandage
- Towels
- Split sheet
Instrumentation
- Basic orthopedic tray
- Soft tissue tray
- Drill bits
- Retractors
- Fixation device
- Screws/ plates
- Compression set
- Power drill
- Cord
Supplies/ Equipment
- Basin set
- Suction
- Power source for drill
- Tourniquet
- Insufflator
- Sheet wadding
- Casting materials
- Blades
- Needle counter
- Sutures
- Solutions
- Medications
Procedure Overview
- An appropriate incision is made over the fracture site, avoiding neurovascular structures.
- If malunion has occurred, an osteotomy (cutting through a bone) is performed to restore alignment.
- Fixation is performed with screws and a compression plate.
- For condylar fractures, a threaded Kirschner (K) wires or screws may be used.
- The wound is irrigated and closed; the arm is immobilized.
Perioperative Nursing Interventions
- Have X-ray capabilities in the room
- Be prepared to assist the surgeon in applying a cast or splint.
- Check tank levels for power equipment before beginning the procedure.
- Have adequate help to hold up and stabilize arm during prepping and draping procedure.
- If distal fracture (near wrist), a hand table (side extension table) may be used.
