DIFFERENT METHODS OF TREATMENT FOR FRACTU RE OF THE HUMERAL SHAFT

The evaluation of 174 humeral shaft fractures treated operatively in o ur institution and a literature review are used to illustrate the indi cations for operative treatment. For some indications, the authors pre fer Hackethal's bundle nails. A simple operative technique and a small approach incision far distant from the fracture site, which prevents the fracture hematoma, and the very low complication rate are the adva ntages of this method, making it an alternative to plating and even to bracing. Operative treatment is clearly indicated for compound fractu res grades II and III. As the humerus unlike the tibia - has a good so ft tissue envelope, plating can be carried out without the danger of i nsufficient soft tissue coverage. Complete radial palsy is also an ind ication for primary operative nerve revision, followed by stable osteo synthesis, preferably with plate. In our series primary radial palsies were observed in 47 (27%) of cases; on revision we found 5 cases of n erve division and 2 of impingement between fragments. Further absolute indications are the rare injuries to the brachial artery, bilateral f ractures, and combination with a forarm fracture (''floating elbow''). Closed fractures without concomitant injuries can generally be manage d conservatively. We have treated 84 of these fractures with Hackethal 's nails. The only serious complications were one non-union (1.2%) and one deep infection (1.2%).