Humeral shaft fracture fixation is an operation to realign and stabilise a fracture of the upper arm bone (humerus) using a plate and screws or an intramedullary nail. Surgery is considered when the fracture is significantly displaced, has associated nerve injury, or cannot be adequately managed with a brace.
For plating: an incision is made along the upper arm. The fracture is exposed, realigned, and fixed with a metal plate and screws. For nailing: a rod is inserted through the shoulder into the canal of the humerus under X-ray guidance. The operation takes one to two hours.
Surgery is recommended for displaced fractures that cannot be maintained in alignment with a brace, fractures with associated radial nerve palsy, open fractures, fractures that extend into the shoulder or elbow joint, and bilateral fractures.
A functional brace (Sarmiento brace) is effective for many humeral shaft fractures, with union rates exceeding 90%. The brace allows gravity to align the fracture while the arm heals over six to twelve weeks.
Standard pre-assessment. Surgery may be performed urgently or planned within days.
Restoration of arm alignment and length, allowing earlier rehabilitation. Union rates with fixation exceed 95%.
Common, particularly with nailing (shoulder) or plating (elbow approach).
The plate may be palpable under the skin.
The radial nerve wraps around the humerus and is at risk during plating. New palsy occurs in approximately 2-5% and usually recovers.
Permanent damage is rare but can cause wrist and finger drop.
Failure to heal requiring further surgery. Approximately 5%.
Wound or deep infection around metalwork.
General anaesthesia. Positioned supine (plating) or beach-chair/lateral (nailing).
A sling for comfort for two to four weeks. Gentle shoulder and elbow exercises begin early. Return to desk work at two to four weeks. Full recovery three to six months.
X-rays at two weeks, six weeks, and three months.
Most radial nerve palsies from humeral fractures recover over three to six months. If there is no recovery, nerve studies and possible exploration may be needed.
Many humeral shaft fractures heal well with a functional brace. Your surgeon will discuss whether surgery or bracing is best for your specific fracture.