Humeral shaft fractures: a review.

Fractures of the humeral shaft are common, account for approximately 3% of all orthopaedic injuries, and result in a significant burden to society from lost productivity and wages. Treatment modalities have greatly evolved since their first description in ancient Egypt (circa 1600 BC); however, fundamental management principles have remained consistent throughout time. Nonoperative management continues as the mainstay for treatment of the majority of these injuries, with acceptable healing in more than 90% of patients. Surgical treatment is generally reserved for open fractures, polytrauma patients, ipsilateral humeral shaft and forearm fractures, and cases in which there is a failure to tolerate or maintain alignment in a functional brace. Advances in internal fixation modalities have improved surgical outcomes. Operative treatment can be performed via external fixation, intramedullary nails, or plate-and-screw constructs, with each method resulting in predictably high union rates. Despite the numerous surgical techniques, plate fixation remains the gold standard for fixation of humeral shaft fractures.