title: The triceps-sparing posterior approach to plating humeral shaft fractures results in a high rate of union and low incidence of complications.
abstract: BACKGROUND
  The optimal treatment of humeral shaft fractures continues to be debated. In the current investigation, we sought to determine the clinical and radiographic outcomes following the plate fixation of humeral shaft fractures utilizing the triceps-sparing posterior approach.
  
  
  METHODS
  A retrospective review identified a consecutive series of 66 humeral shaft fractures (OTA 12-A, 12-B, or 12-C) treated with dual plate fixation via a posterior, triceps-sparing approach between 2005 and 2014 by a single surgeon. Demographics, operative reports, clinical follow-up, and preoperative radiographs were reviewed. Postoperative radiographs were assessed for angular deformity and time to union. Range of motion and strength testing were also reviewed.
  
  
  RESULTS
  A total of 66 humeral shaft fractures were reviewed with a mean clinical follow-up of 8.0 months. The mean time to union was 15.6 ± 11.1 weeks, and there was one case of delayed union. Seventeen of 66 (25.8 %) patients presented with a primary radial nerve palsy following injury, and 14 of the 17 (82 %) of the preoperative radial nerve palsies fully resolved at an average of 31 weeks following injury. Two additional patients developed radial nerve palsies postoperatively (3.0 %).
  
  
  CONCLUSIONS
  This is a large consecutive series of humeral shaft fractures treated with plating through a posterior approach by a single surgeon. The triceps-sparing posterior approach to the humerus results in high union rates and a low incidence of secondary radial nerve palsy.
  
  
  METHODS
  Level IV, Case Series.
authors.affiliation: Hospital for Special Surgery, 535 E. 70th St., New York, 10021, New York, United States. gausdene@hss.edu.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Gausden
authors.affiliation: Hospital for Special Surgery, 535 E. 70th St., New York, 10021, New York, United States.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Christ
authors.affiliation: Hospital for Special Surgery, 535 E. 70th St., New York, 10021, New York, United States.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Warner
authors.affiliation: Hospital for Special Surgery, 535 E. 70th St., New York, 10021, New York, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Levack
authors.affiliation: Weill Cornell Medical College, New York, 10021, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nellestein
authors.affiliation: Weill Cornell Medical College, New York, 10021, USA.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery*; D015994:Incidence; D008297:Male; D018482:Muscle, Skeletal / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Humeral shaft fracture; ORIF; Osteosynthesis; Plating of humeral shaft fractures; Posterior approach to humeral shaft; Radial nerve palsy