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Humeral shaft fractures account for about 1-3% of all fractures in adults and are classified according their location, open or closed status and the pattern of fracture lines. Conservative treatment with functional bracing has been the most widely accepted treatment option in the last decades, however an increasing number of patients is treated surgically. This article overviews the indications, pros and cons of the most used fixation methods. Plates and nails are the most used devices, have widely overlapping indications, mostly depending on surgeon’s preference. Plate fixation can be used for almost all humeral fractures and represent the best option for transitional fractures (proximal or distal shaft), particularly those with intraarticular involvement. MIPO techniques combines the advantages of plates with less soft tissue impairment. Fractures associated with nervous lesions deserve special considerations: the need to explore the radial nerve can drive the choice of implant more than the fracture itself. Intramedullary implants are the best option for pathological fractures of the humeral shaft, and can appropriately replace plates fixation for middle third or proximal shaft even with intraarticular simple patterns. External fixation is rarely indicated, mainly for damage control and/or extensive soft tissue damage.

Appropriateness of fixation methods - Trauma Meeting 2019: humeral diaphysis