Fixation of Fractures of the Shaft of the Humerus with Dynamic Compression Plating or Intramedullary Fixation. A Review of the Effect of Treatment on Post-Operative Function and Complications
Abhijit Singh Clair, Govind Singh Dhillon and Harpal Singh Uppal*
The majority of humeral shaft fractures can successfully be treated non-surgically by various methods of reduction and immobilisation (including U-shaped splints or types of functional bracing) with high union rates of approximately 90%. These methods have been found to give better results in most common humeral shaft fractures and with fewer complications than the use of open reduction and internal fixation. However one may appreciate that no modern studies have replicated these results recently. Operative treatment has usually been reserved for the treatment of non-union, multiply injured patients, neurovascular injuries, open fractures, “floating elbows” and in cases where non-operative treatments cannot adequately maintain a satisfactory reduction.
We report the results of a review of the literature comparing humeral dynamic compression plating to humeral intramedullary nailing. Our review concludes that the current evidence base shows similar levels of humeral function and complications with either technique. Intramedullary nailing is associated with poorer shoulder function and dynamic compression plating is associated with infection. The current evidence base supports using either technique depending on which surgical complications are more palatable and on the familiarity and proficiency of the surgeons with an individual technique.