[Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature].
OBJECTIVE
Based on our experience with plate fixation of humeral shaft fractures and an analysis of the international literature, we attempted to answer the following questions. What functional outcome and what complications can be expected after surgery? Are the classical complications of open fracture surgery (screw fixation, wiring, plate fixation without compression.) as frequent after plate fixation using the Müller technique?


METHODS
We reviewed our series of 156 humeral shaft fractures (61 p. 100 men, mean age 45 years) including 21 cases of multiple trauma and 24 multiple fractures. A floating elbow was present in 8 cases and skin opening in 16. Initial radial deficiency was observed in 28 cases. Plate fixation was the only method used for the humeral shaft fractures. We used the modified Stewart and Hundley classification.


RESULTS
Postoperative paralysis occurred in 8 cases (5.1 p. 100, 5 complete paralysis); only one patient suffered persistent severe sequelae. There were also 8 malunions and 3 late consolidations. Consolidation rate was 94.2 p. 100, sepsis rate was 1.5 p. 100. Good or very good outcome was achieved in 86.6 p. 100 of the cases.


CONCLUSIONS
In the literature, (71 series, 5 000 patients), plate fixation of humeral shaft fractures has given very good functional results with few initial failures, malunions or cases of sepsis. Radial paralysis is cited as a complication in 6.5 p. 100 of all plate fixations but is reversible in 90 p. 100 of cases. Classical orthopedic methods and centromedullar techniques produce more stiffness. The Sarmiento cuff can give good results after rigorous patient selection.


CONCLUSIONS
Plate fixation according to the Müller technique is a reliable osteosynthesis method with few initial failures or malunions as evidenced by data in the literature. Infection is also rare. Although the radial nerve risk makes this technique rather difficult, excellent functional results can be achieved.
Paris
H
H
Service de chirurgie orthopédique et traumatologie, Hôpital Nord, chemin des Bourrelys, 13915 Marseille Cedex, France.
Tropiano
P
P
Clouet D'orval
B
B
Chaudet
H
H
Poitout
D G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000209:etiology; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000209:etiology; D011826:Radial Nerve / Q000293:injuries / Q000503:physiopathology; D016896:Treatment Outcome