Skip to main content
SpringerLink
Log in

The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the triceps-sparing posterior approach.

Materials and methods

A retrospective review identified a consecutive series of 66 humeral shaft fractures (OTA 12-A, 12-B, or 12-C) treated with dual plate fixation via a posterior, triceps-sparing approach between 2005 and 2014 by a single surgeon. Demographics, operative reports, clinical follow-up, and preoperative radiographs were reviewed. Postoperative radiographs were assessed for angular deformity and time to union. Range of motion and strength testing were also reviewed.

Results

A total of 66 humeral shaft fractures were reviewed with a mean clinical follow-up of 8.0 months. The mean time to union was 15.6 ± 11.1 weeks, and there was one case of delayed union. Seventeen of 66 (25.8 %) patients presented with a primary radial nerve palsy following injury, and 14 of the 17 (82 %) of the preoperative radial nerve palsies fully resolved at an average of 31 weeks following injury. Two additional patients developed radial nerve palsies postoperatively (3.0 %).

Conclusion

This is a large consecutive series of humeral shaft fractures treated with plating through a posterior approach by a single surgeon. The triceps-sparing posterior approach to the humerus results in high union rates and a low incidence of secondary radial nerve palsy.

Level of evidence

Level IV, Case Series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY (1985) The results of plating humeral shaft fractures in patients with multiple injuries. The Sunnybrook experience. J Bone Joint Surg Br 67:293–296

    Article  CAS  PubMed  Google Scholar 

  2. Brinker MR, O’Connor DP (2004) The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. J Bone Joint Surg Am 86-A:290–297

    Article  PubMed  Google Scholar 

  3. Chapman JR, Henley MB, Agel J, Benca PJ (2000) Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 14:162–166

    Article  CAS  PubMed  Google Scholar 

  4. Claessen FM, Peters RM, Verbeek DO, Helfet DL, Ring D (2015) Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elb Surg 24:e307–e311

    Article  Google Scholar 

  5. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  PubMed  Google Scholar 

  6. Denard A. Jr, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA (2010) Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics 33(8). doi:10.3928/01477447-20100625-16

  7. Esmailiejah AA, Abbasian MR, Safdari F, Ashoori K (2015) Treatment of humeral shaft fractures: minimally invasive plate osteosynthesis versus open reduction and internal fixation. Trauma Mon 20:e26271

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gardner MJ, Griffith MH, Demetrakopoulos D, Brophy RH, Grose A, Helfet DL, Lorich DG (2006) Hybrid locked plating of osteoporotic fractures of the humerus. J Bone Joint Surg Am 88:1962–1967

    PubMed  Google Scholar 

  9. Gerwin M, Hotchkiss RN, Weiland AJ (1996) Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am 78:1690–1695

    Article  CAS  PubMed  Google Scholar 

  10. Gosler MW, Testroote M, Morrenhof JW, Janzing HM (2012) Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev 1:CD008832

    PubMed  Google Scholar 

  11. Huttunen TT, Kannus P, Lepola V, Pihlajamaki H, Mattila VM (2012) Surgical treatment of humeral-shaft fractures: a register-based study in Finland between 1987 and 2009. Injury 43:1704–1708

    Article  PubMed  Google Scholar 

  12. Kim JW, Oh CW, Byun YS, Kim JJ, Park KC (2015) A prospective randomized study of operative treatment for noncomminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis. J Orthop Trauma 29:189–194

    Article  PubMed  Google Scholar 

  13. Koca K, Ege T, Kurklu M, Ekinci S, Bilgic S (2015) Spiral-medial butterfly fractures (AO-12-B1) in distal diaphysis of humerus with rotational forces: preliminary results of open reduction and plate-screw fixation. Eur Rev Med Pharmacol Sci 19:4494–4497

    CAS  PubMed  Google Scholar 

  14. Kosmopoulos V, Luedke C, Nana AD (2015) Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study. Technol Health Care 23:83–92

    Article  PubMed  Google Scholar 

  15. Levy JC, Kalandiak SP, Hutson JJ, Zych G (2005) An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 19:43–47

    Article  PubMed  Google Scholar 

  16. Mahabier KC, Van Lieshout EM, Bolhuis HW, Bos PK, Bronkhorst MW, Bruijninckx MM, De Haan J, Deenik AR, Dwars BJ, Eversdijk MG, Goslings JC, Haverlag R, Heetveld MJ, Kerver AJ, Kolkman KA, Leenhouts PA, Meylaerts SA, Onstenk R, Poeze M, Poolman RW, Punt BJ, Roerdink WH, Roukema GR, Sintenie JB, Soesman NM, Tanka AK, Ten Holder EJ, Van der Elst M, Van der Heijden FH, Van der Linden FM, Van der Zwaal P, Van Dijk JP, Van Jonbergen HP, Verleisdonk EJ, Vroemen JP, Waleboer M, Wittich P, Zuidema WP, Polinder S, Verhofstad MH, Den Hartog D (2014) HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER): a multicenter comparative observational study. BMC Musculoskelet Disord 15:39. doi:10.1186/1471-2474-15-39

    Article  PubMed  PubMed Central  Google Scholar 

  17. Malhan S, Thomas S, Srivastav S, Agarwal S, Mittal V, Nadkarni B, Gulati D (2012) Minimally invasive plate osteosynthesis using a locking compression plate for diaphyseal humeral fractures. J Orthop Surg (Hong Kong) 20:292–296

    Article  Google Scholar 

  18. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium––2007: orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133

    Article  CAS  PubMed  Google Scholar 

  19. Matsunaga FT, Tamaoki MJ, Matsumoto MH, dos Santos JB, Faloppa F, Belloti JC (2013) Treatment of the humeral shaft fractures–minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial. Trials 14:246. doi:10.1186/1745-6215-14-246

    Article  PubMed  PubMed Central  Google Scholar 

  20. Meloy GM, Mormino MA, Siska PA, Tarkin IS (2013) A paradigm shift in the surgical reconstruction of extra-articular distal humeral fractures: single-column plating. Injury 44:1620–1624

    Article  PubMed  Google Scholar 

  21. Prasarn ML, Ahn J, Paul O, Morris EM, Kalandiak SP, Helfet DL, Lorich DG (2011) Dual plating for fractures of the distal third of the humeral shaft. J Orthop Trauma 25:57–63

    Article  PubMed  Google Scholar 

  22. Ring D, Jawa A, Cannada L (2015) Clinical faceoff: are distal-third diaphyseal humerus fractures best treated nonoperatively? Clin Orthop Relat Res 474(2):310–314

    Article  PubMed  Google Scholar 

  23. Rubel IF, Kloen P, Campbell D, Schwartz M, Liew A, Myers E, Helfet DL (2002) Open reduction and internal fixation of humeral nonunions: a biomechanical and clinical study. J Bone Joint Surg Am. 84-A:1315–1322

    Article  PubMed  Google Scholar 

  24. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82:478–486

    Article  CAS  PubMed  Google Scholar 

  25. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG (1977) Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am 59:596–601

    Article  CAS  PubMed  Google Scholar 

  26. Schatzker J, Tile M (1996) The rationale of operative fracture care, 3rd edn. Springer, New York, pp 83–94

    Book  Google Scholar 

  27. Scolaro JA, Voleti P, Makani A, Namdari S, Mirza A, Mehta S (2014) Surgical fixation of extra-articular distal humerus fractures with a posterolateral plate through a triceps-reflecting technique. J Shoulder Elb Surg 23:251–257

    Article  Google Scholar 

  28. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 87:1647–1652

    Article  CAS  PubMed  Google Scholar 

  29. Singh AK, Narsaria N, Seth RR, Garg S (2014) Plate osteosynthesis of fractures of the shaft of the humerus: comparison of limited contact dynamic compression plates and locking compression plates. J Orthop Traumatol 15:117–122

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sullivan R (1996) The identity and work of the ancient Egyptian surgeon. J R Soc Med 89:467–473

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD (2000) Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma 49:278–280

    Article  CAS  PubMed  Google Scholar 

  32. Vander Griend R, Tomasin J, Ward EF (1986) Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am 68:430–433

    Article  CAS  PubMed  Google Scholar 

  33. Wang C, Li J, Li Y, Dai G, Wang M (2015) Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique? J Shoulder Elb Surg 24:1741–1748

    Article  Google Scholar 

  34. Wang X, Zhang P, Zhou Y, Zhu C (2014) Secondary radial nerve palsy after internal fixation of humeral shaft fractures. Eur J Orthop Surg Traumatol 24:331–333

    Article  PubMed  Google Scholar 

  35. Wilairatana V, Prasongchin P (2001) The open reduction and internal fixation of humeral diaphysis fracture treatment with a medial approach. J Med Assoc Thail 84(Suppl 1):S423–S427

    Google Scholar 

  36. Yi JW, Oh JK, Han SB, Shin SJ, Oh CW, Yoon YC (2013) Healing process after rigid plate fixation of humeral shaft fractures revisited. Arch Orthop Trauma Surg 133:811–817

    Article  PubMed  Google Scholar 

  37. Yin P, Zhang L, Mao Z, Zhao Y, Zhang Q, Tao S, Liang X, Zhang H, Lv H, Li T, Tang P (2014) Comparison of lateral and posterior surgical approach in management of extra-articular distal humeral shaft fractures. Injury 45:1121–1125

    Article  PubMed  Google Scholar 

  38. Zhao JG, Wang J, Wang C, Kan SL (2015) Intramedullary nail versus plate fixation for humeral shaft fractures: a systematic review of overlapping meta-analyses. Medicine (Baltimore) 94:e599

    Article  Google Scholar 

Download references

Acknowledgments

Funding was provided by May and Samuel Rudin Family Foundation (US).

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 535 E. 70th St., New York, 10021, New York, United States

    Elizabeth B. Gausden, Alexander B. Christ, Stephen J. Warner & Ashley Levack

  2. Weill Cornell Medical College, New York, 10021, USA

    Andrew Nellestein & Dean G. Lorich

Authors
  1. Elizabeth B. Gausden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander B. Christ
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen J. Warner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Levack
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Nellestein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dean G. Lorich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elizabeth B. Gausden.

Ethics declarations

Conflict of interest

None of the authors have financial disclosures related to the material presented here. Weill Cornell Medical College Institutional Review Board (IRB) approved this study #1502015915.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gausden, E.B., Christ, A.B., Warner, S.J. et al. The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications. Arch Orthop Trauma Surg 136, 1683–1689 (2016). https://doi.org/10.1007/s00402-016-2578-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2578-6

Keywords

Search

Navigation