Humeral Shaft Fracture Fixation

Indications

• Most heal in a functional brace (Sarmiento)
• Surgery for open fractures, vascular injury, floating elbow, polytrauma and pathological fractures
• Failed closed treatment and segmental fractures
• Radial nerve palsy at presentation is not an indication for exploration in closed fractures

Position

• Anterolateral approach, supine with arm board
• Posterior approach, prone or lateral
• Image intensifier and radiolucent arm board

Operative Steps

1. Anterolateral approach for proximal and middle thirds, splitting brachialis
2. Posterior approach for the distal third, identifying the radial nerve in the spiral groove
3. The radial nerve crosses the posterior humerus about 20 cm above the medial epicondyle and 14 cm above the lateral epicondyle
4. Compression plating, at least three bicortical screws each side
5. Intramedullary nailing for pathological and segmental fractures, with more shoulder pain
6. Minimally invasive anterior bridge plating avoids the radial nerve
7. Protect the radial nerve with a vessel loop during plating

Postoperative Care

• Early elbow and shoulder motion
• Radiographs at 2, 6 and 12 weeks
• Return to heavy work after union

Complications

• Radial nerve palsy, most primary closed palsies recover
• Nonunion
• Shoulder pain after antegrade nailing
• Infection
• Nonunion, more common with transverse fractures
• Infection
• Shoulder pain and stiffness after antegrade nailing

Related Pages

• Adult Fractures of the Shoulder, Upper Arm & Elbow
• Arm and humerus approaches

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.