Prospective RCT at a Level I trauma center randomizing 84 patients with humeral diaphyseal fractures to antegrade locked IM nailing (n=38) or compression plating (n=46). The study compared fracture healing, functional ROM at shoulder and elbow, nerve recovery, and complications at average 13-month follow-up. The central question: which fixation method is superior for achieving union with fewer complications?
The fixation debate for humeral shaft fractures has long centered on whether nails or plates heal better. This RCT settles that question: healing rates are statistically identical at roughly 90% union by 16 weeks. The real differences lie in WHERE complications occur, not whether they occur.
When you choose antegrade nailing, counsel the patient on a real 16% risk of shoulder pain and stiffness — even with careful rotator cuff repair at nail entry. When you choose plating for a distal-third fracture, recognize that the plate end will likely sit near the olecranon fossa, and elbow stiffness is a predictable consequence.
This paper is why fracture location should drive implant selection: proximal and middle-third fractures tolerate nailing well, while distal-third fractures may favor nailing specifically to avoid plate-related elbow morbidity.
The 73-83% radial nerve recovery rate (equivalent between groups) is a useful benchmark when counseling patients with preoperative palsy. And the complete resolution of all iatrogenic postoperative palsies within 3 months is reassuring when intraoperative nerve injury is suspected.
Prospective RCT at a Level I trauma center randomizing 84 patients with humeral diaphyseal fractures to antegrade locked IM nailing (n=38) or compression plating (n=46). The study compared fracture healing, functional ROM at shoulder and elbow, nerve recovery, and complications at average 13-month follow-up. The central question: which fixation method is superior for achieving union with fewer complications?
The fixation debate for humeral shaft fractures has long centered on whether nails or plates heal better. This RCT settles that question: healing rates are statistically identical at roughly 90% union by 16 weeks. The real differences lie in WHERE complications occur, not whether they occur.
When you choose antegrade nailing, counsel the patient on a real 16% risk of shoulder pain and stiffness — even with careful rotator cuff repair at nail entry. When you choose plating for a distal-third fracture, recognize that the plate end will likely sit near the olecranon fossa, and elbow stiffness is a predictable consequence.
This paper is why fracture location should drive implant selection: proximal and middle-third fractures tolerate nailing well, while distal-third fractures may favor nailing specifically to avoid plate-related elbow morbidity.
The 73-83% radial nerve recovery rate (equivalent between groups) is a useful benchmark when counseling patients with preoperative palsy. And the complete resolution of all iatrogenic postoperative palsies within 3 months is reassuring when intraoperative nerve injury is suspected.