Uncomplicated Diaphyseal Fractures of the Humerus: Plating versus Nailing: Trichy Rajagopal 29th June 2006Most uncomplicated diaphyseal fractures of the Humerus are treated non-operatively. Successful healing occurs in more than 90% of the cases with non-operative treatment.
In general indications for operative treatment are:
· Unsatisfactory closed reduction · Open fractures · Multiple Injuries · Associated Vascular Injury · Radial Nerve Palsy after manipulation or worsening Neurological deficit · Segmental fractures · Pathological fractures · Floating Shoulder or elbow
Advantages of Nails:
· Less soft tissue disruption · Preserves fracture Haematoma
Problems with Nails:
· Shoulder pain and stiffness · Impingement from prominent hardware · Risk of further fracture comminution during reaming or nail insertion
Advantages of Plates:
· Anatomical reduction · Easier during neurovascular exploration and in open fractures
Problems with Plates:
·
Greater disruption of soft-tissue envelope
·
Risk of infection
·
Potential injury to the radial nerve
· Poor fixation in osteoporotic bone
·
Possible need for removal of plate at a later date
Evidence:
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