[Differential treatment of diaphyseal humerus fractures]

The evaluation of 174 humeral shaft fractures treated operatively in our institution and a literature review are used to illustrate the indications for operative treatment. For some indications, the authors prefer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the advantages of this method, making it an alternative to plating and even to bracing. Operative treatment is clearly indicated for compound fractures grades II and III. As the humerus--unlike the tibia--has a good soft tissue envelope, plating can be carried out without the danger of insufficient soft tissue coverage. Complete radial palsy is also an indication for primary operative nerve revision, followed by stable osteosynthesis, preferably with plate. In our series primary radial palsies were observed in 47 (27%) of cases; on revision we found 5 cases of nerve division and 2 of impingement between fragments. Further absolute indications are the rare injuries to the brachial artery, bilateral fractures, and combination with a forearm fracture ("floating elbow"). Closed fractures without concomitant injuries can generally be managed conservatively. We have treated 84 of these fractures with Hackethal's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).