Proximal to Middle One-Third Humerus Shaft Fractures may Lead to Poorer Shoulder Function Compared to Middle to Distal One-Third Humerus Shaft Fractures following Internal Fixation

Abstract

Background

The radiographic and functional outcomes following an anterior approach for plate fixation of humeral shaft fractures were evaluated and compared with those of a group having undergone plate fixation from a posterior approach. The hypothesis was that there would be no significant difference between these two groups in shoulder, elbow and overall upper extremity function.

Methods

We retrospectively reviewed radiographs and data for 78 humerus shaft fractures. Twenty-six patients returned to complete the Constant–Murley Score (CMS), Simple Shoulder Test (SST), Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results

The overall median CMS [76.5 (A) versus 83.5 (P)] approached a significant difference between anterior and posterior fixation groups (p = 0.07). Active shoulder elevation was significantly better (p = 0.03) in the posterior group. There was no significant difference in median DASH score (p = 0.51), MEPS score (p = 0.69), nor in 10 of 12 individual responses on the SST. Fracture union rate was 97%.

Discussion

Anterior fixation of humeral shaft fractures yields satisfactory upper extremity functional outcomes that are comparable to those of extremities that have undergone posterior fixation. However, shoulder function tends to be better following posterior fixation, possibly as a result of anterior approaches being more commonly performed for more proximal shaft fractures.