Surgical treatment of humeral shaft fractures--the Basel experience

One hundred twenty seven patients with fractures of the humeral shaft were treated by open reduction and internal fixation using 4.5-mm dynamic compression plates (DCP). Seventy one osteosyntheses were performed primarily, 36 following attempted closed reduction, and 20 secondarily after a failed conservative treatment of about 8 weeks. A primary radial nerve palsy was present in 19 patients, and appeared subsequently in four additional patients. One hundred two of the 127 patients could be clinically and radiologically examined 1 year after internal fixation: 89 patients (87.3%) had excellent or good results with full functional recovery. Thirteen patients (12.7%) showed a limited range of motion of either the shoulder or elbow or both. This was mostly because of other fractures of the same limb or persistent neurologic impairment. We observed two transitory postoperative nerve palsies, five early failures of internal fixation because of technical errors, two pseudarthroses and four postoperative infections, which healed with one exception by suction drainage and early removal of the plate. We conclude that a correct plate fixation of humeral shaft fractures in a selected group of patients represents an alternative to conservative treatment with the advantage of greater patient comfort.