title: Medial approach to treat humeral mid-shaft fractures: a retrospective study.
abstract: BACKGROUND
  Plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. However, the outcomes of humeral shaft fracture fixation using a medial approach are rarely reported. The aim of this study is to explore the management and outcomes of humeral mid-shaft fractures fixed through a medial incision.
  
  
  METHODS
  Thirty-four patients who sustained a humeral mid-shaft fracture and underwent an open-reduction internal fixation (ORIF) in our department between January 2010 and January 2013 were included in this study. Sixteen patients had an ORIF performed through a medial approach, while the remaining 18 were fixed through an anterolateral approach. Postoperative clinical and radiographic results were reviewed.
  
  
  RESULTS
  There were no significant differences in the blood loss and the range of motion of the shoulder and elbow between the anterolateral and medial fixation groups. One patient in the medial group and two patients in the anterolateral group had radial nerve dysfunction that improved after 8, 3 and 6 weeks, respectively. All patients healed radiographically except one from the anterolateral group who underwent grafting and re-fixation for a non-union. No vascular injuries, infections, malunions, broken plates or loose screws were noted in either group.
  
  
  CONCLUSIONS
  The medial approach to the humerus had equivalent outcomes to anterolateral fixation. It is an available choice for humeral mid-shaft fracture fixation in cases where there is no need to expose the radial nerve. The medial approach does not require a pre-bent plate and creates a large operative exposure. A well-hidden incision can also be designed, improving cosmetic outcomes. However, the medial approach is not suitable to proximal or distal humerus fractures.
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Junwei
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Shihong
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Baisheng
authors.initials: B
authors.lastname: Fu
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Jinlei
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Yongliang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Maoyuan
authors.initials: M
authors.lastname: Xin
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China.
authors.forename: Qinghu
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.
authors.forename: Tong-Chuan
authors.initials: TC
authors.lastname: He
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China. 1065715315@qq.com.
authors.forename: Fu
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, China. 408992708@qq.com.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000502:physiology; D055815:Young Adult
keywords: Humeral mid-shaft fractures; Medial approach; Plate fixation