This 2012 JAAOS review by Carroll et al. covers the full management spectrum of humeral shaft fractures — from functional bracing to ORIF, MIPO, and IM nailing — with focused sections on radial nerve palsy, nonunion, and osteoporotic bone. It addresses both operative indications and the comparative trade-offs among surgical techniques.
When evaluating a humeral shaft fracture, brace it unless there is polytrauma, open injury, vascular compromise, floating elbow, or failed alignment — and document the neurologic exam first, because radial nerve palsy (especially with distal third patterns) is common and usually recovers without surgery.
When you do operate, MIPO or plate fixation protects the radial nerve better than IM nailing, which trades nerve safety for higher shoulder morbidity and reoperation risk.
This 2012 JAAOS review by Carroll et al. covers the full management spectrum of humeral shaft fractures — from functional bracing to ORIF, MIPO, and IM nailing — with focused sections on radial nerve palsy, nonunion, and osteoporotic bone. It addresses both operative indications and the comparative trade-offs among surgical techniques.
When evaluating a humeral shaft fracture, brace it unless there is polytrauma, open injury, vascular compromise, floating elbow, or failed alignment — and document the neurologic exam first, because radial nerve palsy (especially with distal third patterns) is common and usually recovers without surgery.
When you do operate, MIPO or plate fixation protects the radial nerve better than IM nailing, which trades nerve safety for higher shoulder morbidity and reoperation risk.