After a motor vehicle collision, what is the best next management step for a patient with a midshaft humeral fracture?

In the case of a midshaft humeral fracture following a motor vehicle collision, the best next management step involves open reduction and surgical exploration. This approach is often necessary due to the risk of associated injuries, particularly to the radial nerve, which can be compromised in such fractures.

Midshaft humeral fractures are frequently characterized by significant displacement and can lead to functional deficits if not appropriately aligned. Open reduction allows for precise realignment of the fracture fragments and stabilization, either through internal fixation or other methods, which is crucial for proper healing and restoring function to the arm.

Surgical exploration is indicated when there is concern for neurovascular compromise, which can occur in high-energy trauma situations. By performing an open reduction, the surgeon can also directly address any related injuries, ensuring better outcomes for the patient.

Conservative methods, such as a neutral wrist splint or a long arm hanging cast, may not provide sufficient stabilization or alignment for a midshaft fracture, particularly in the context of trauma. An electromyogram is not typically used as an immediate management step for fractures, as it assesses nerve function rather than treating the injury. Thus, open reduction and exploration is the most appropriate next step in managing a midshaft humeral fracture in this scenario.