A critical analysis review from Vanderbilt (JBJS Reviews, 2015) synthesizing evidence on nonoperative and operative management of humeral shaft fractures. Grades treatment recommendations using JBJS Levels of Evidence, covering functional bracing, plate fixation, intramedullary nailing, and management of associated radial nerve palsy.
When managing an isolated humeral shaft fracture, default to functional bracing unless operative indications are met — but flag proximal-third location or simple fracture pattern (OTA type A) as higher nonunion risk warranting closer follow-up.
When you do operate, plating is the workhorse: it avoids the shoulder dysfunction and malrotation risk that reliably accompanies antegrade IMN, reserving nailing for pathologic, segmental, or severely comminuted cases.
A critical analysis review from Vanderbilt (JBJS Reviews, 2015) synthesizing evidence on nonoperative and operative management of humeral shaft fractures. Grades treatment recommendations using JBJS Levels of Evidence, covering functional bracing, plate fixation, intramedullary nailing, and management of associated radial nerve palsy.
When managing an isolated humeral shaft fracture, default to functional bracing unless operative indications are met — but flag proximal-third location or simple fracture pattern (OTA type A) as higher nonunion risk warranting closer follow-up.
When you do operate, plating is the workhorse: it avoids the shoulder dysfunction and malrotation risk that reliably accompanies antegrade IMN, reserving nailing for pathologic, segmental, or severely comminuted cases.