Plate osteosynthesis improved recovery, function after humeral shaft fracture

Mark A. Mighell, MD

The authors present a well-designed prospective, multicenter study that attempts to determine if plating or intramedullary nailing is the gold standard for humeral shaft fractures. There were 245 patients included in this series, 76 were treated with plating and 169 were treated with nailing. A total of 121 surgeons operated on one or more patients. Plating was performed by 47 surgeons, and nailing was performed by 94 surgeons. The primary questions most surgeons ask when trying to decide between these two methods are: What will result in a predictable union and which technique will have the fewest complications? This study addresses each of these topics.

In this series, plate fixation resulted in fewer implant-related complications and a higher and faster union rate. This is consistent with previous studies in the literature. The authors also reported that temporary radial nerve palsy occurred in 10.5% of the patients who underwent plate fixation. Only one patient (0.6%) developed a radial nerve palsy in the cohort that underwent nailing. While the nerve palsies were temporary, the paper does not give the reader a good understanding of what to expect if this complication were to occur. They reported spontaneous resolution, but they could have provided average time to resolution and outlined the disabilities of those patients who suffered nerve palsies and the treatment that they required. Nailing of these fractures was associated with a higher reoperation rate. Complications that occurred with nailing required secondary surgical intervention in 28 patients as compared with two in the plating group.

The authors conclude that plating was superior to nailing. However, lack of standardization may have caused an unknown bias in the study results. In my opinion, plate fixation results in higher union rates and a lower complication rate that must be balanced against a higher incidence of radial nerve palsies.