GA maintained at 2.5-3% iso/O2 via mask.  No complications, smooth recovery.  

Imaging shows there is still not well-mineralized bridging of the R humeral fracture site.  Minimal progression since last study.  There is fibrous callus present.  On palpation there is slight movement at the fracture site.

Placed wing-to-body wrap with 2" micropore tape.

AMS

Induced 5% iso, maintained around 2% on facemask. Removed body wrap and obtained VD, craniocaudal projections. There appears to be bridging bone formation across the humeral fracture site that was not previously present. This is thin, and appears better on craniocaudal than the VD views. Radiology recommended that while healed, it is best to be cautious and keep patient from flying for now though until bone callus is thicker. 

Lateral view of right wing showed piece of ESF pin in distal ulna. The previous fracture showed boney callus formation and fracture pieces were not in alignment. No new fractures were noted on radiographs

Progression of callus formation, with bridging of cortices. One region on caudal aspect of cortex lacks callus formation.

Some evidence of bridging between fracture segments, some callus formation. ESF pins and IM pin intact.

Retrograde IM pin with two external skeletal fixator pins (positive
profile)
Prior to surgery an ultrasound-guided right brachial plexus block
was performed with 0.87mg bupivacaine. The patient was placed
in ventral recumbency with the right wing extended. Skin staples
were removed and the edge of the distal humeral bone fragment
was debrided with ronguers until healthy bone remained and hemorrhage
was present. The fragment was flushed with sterile saline, and
the proximal fragment was assessed similarly. An intramedullary
pin was carefully inserted into the proximal fragment and then
aligned and inserted into the distal fragment to better align
and appose both fragments. The skin was closed in a simple continuous
pattern. A 1.1 positive profile pin was inserted just proximal
to the humeral condyles, and a 1.6 positive profile pin was inserted
in the middle of the bone near the pectoral crest. 

Humeral rads. A craniolaterally displaced open, transverse, mid-diaphyseal fracture of the right humerus is appreciated. No fissures, comminution, or other fractures noted. The narrowest part of the humerus measures ~4.9mm, and the pectoral crest measures ~6mm. No other concerns are noted. 

Post-op right humeral fracture repair. An intramedullary pin is present in the medulla of the right humerus. An additional pin is positioned transverse through the pectoral crest and another through the distal humerus just proximal to the condyles.