Adequate surgical debridement is the crucial first step in the care of any open fracture. Debridement of a small open fracture wound from inside out may be performed through a separate standard surgical approach to the humerus, if plate fixation has been selected.
Larger wounds should be debrided.
If definitive stabilization with a plate is planned, if possible larger wounds may be extended to permit a more typical exposure of the humerus.
Using a separate incision is better if the wound location does not readily permit extension into a standard approach.
If nail fixation is chosen, the open fracture is usually debrided through its original wound.
In severe soft tissue injuries, stabilization with external fixation is recommended. In these cases, the approach addresses the individual soft tissue situation and comprises: