title: Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study.
abstract: BACKGROUND
  There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach.
  
  
  METHODS
  We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.
  
  
  RESULTS
  During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group.
  
  
  CONCLUSIONS
  The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.
authors.affiliation: The Department of Surgery, University Hospital Split, Croatia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Boschi
authors.forename: Zenon
authors.initials: Z
authors.lastname: Pogorelic
authors.forename: Gordan
authors.initials: G
authors.lastname: Gulan
authors.forename: Katarina
authors.initials: K
authors.lastname: Vilovic
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Stalekar
authors.forename: Kanito
authors.initials: K
authors.lastname: Bilan
authors.forename: Leo
authors.initials: L
authors.lastname: Grandic
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001860:Bone Plates; D001916:Brachial Artery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D053580:Muscle Strength; D009138:Musculocutaneous Nerve / Q000293:injuries*; D061646:Operative Time; D011826:Radial Nerve / Q000293:injuries*; D012189:Retrospective Studies; D016896:Treatment Outcome