Plating of Acute Humeral Diaphyseal Fractures Through an Anterior Approach in Multiple Trauma Patients

Objective: We evaluated the clinical and long-term functional outcomes of humeral diaphyseal fractures treated with acute anterior plating in a trauma population. Design: Single-center, retrospective cohort analysis with long-term prospective follow-up. Setting: Urban, Level I trauma center. Patients: Ninety-six patients with high-energy fractures of the humeral shaft were treated over a 10-year period. Intervention: All patients were treated by a standard surgical protocol of open reduction through an anterior approach with small or large fragment fixation in the supine position. Main Outcome Measurements: Mechanism of injury, time to union, complications, and range of motion during clinical follow-up were obtained. We also prospectively assessed long-term strength, range of motion, and perceptions of disability using the Disabilities of the Arm, Shoulder and Hand questionnaire. Results: Mean time to surgery was 5 days (standard deviation, 11 days); 97.5% of patients achieved union in an average of 16.9 weeks (range, 6–56 weeks). Complications included two postoperative infections, two nonunions, and three implant failures. Long-term follow-up (n = 34) averaged 4.75 years (range, 1.4–10.8 years). On average, no significant differences between the injured and uninjured extremities were seen in range of motion at the shoulder and elbow with the exception of shoulder flexion. A modest loss of upper extremity strength in the injured arm was appreciated. The mean Disabilities of the Arm, Shoulder and Hand score was 25.9 (range, 0–79). Conclusions: A standard anterior surgical approach with small fragment fixation is a safe and effective treatment for humeral shaft fractures in multiple trauma patients. We show a high union rate and few complications, although a modest loss of function and some perceived disability exists in the long-term.