title: The treatment of distal third humeral diaphyseal fractures: Is there still a place for the external fixation?
abstract: BACKGROUND
  The treatment for humeral diaphyseal fractures is still controversial. The purpose of this study was to evaluate the clinical and radiographic outcomes of treating humeral distal third diaphyseal fractures by using external fixation technique.
  
  
  METHODS
  We retrospectively review 65 cases of diaphyseal humeral fractures (31 type A, 23 type B and 11 type C of the AO/OTA classification) treated with external fixation (Orthofix FAD small) between 2008 and 2013. The mean follow-up was 48 months (24-72 months). There were 12 open fractures; however, no cases of concomitant vascular injury were described. The transolecranic traction was always applied to promote partial reduction through ligamentotaxis. In case of interposition of soft tissues impeding reduction, a small incision was performed allowing mobilization of bone ends.
  
  
  RESULTS
  All fractures resulted healed at a mean of 11 weeks (range 9-13 weeks); the average time of removal of the external fixator was 88 days (range 65-95 days). At the last follow-up, the mean elbow flexion was 132.6° (Min 126°-Max 137°) and the mean elbow extension was 6.4° (Max 0°-Min 13°). The Cassebaum's index rated as excellent in 47.8 % (31 patients), good in 37 % (24 patients), fair in 9.2 % (6 patients) and poor in 6 % (4 patients). The mean DASH score at the final follow-up was 14.7 (range 0-33); 15 patients had a range score between 10 and 20, 43 had less than 10, and seven had more than 20. We observed three cases of superficial infections and two cases of acute radial nerve palsy recovered within 3 months.
  
  
  CONCLUSIONS
  According to the excellent clinical results and full rate of consolidation, we state external fixation as a valid option in the treatment of distal third humeral diaphyseal fractures.
authors.affiliation: Department of Trauma and Orthopaedics, Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Tartaglia
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy. dott.gvicenti@gmail.com.
authors.forename: G
authors.identifier: http://orcid.org/0000-0002-7412-7990
authors.initials: G
authors.lastname: Vicenti
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Carrozzo
authors.affiliation: Department of Orthopedics and Traumatology, Monsignor Raffaele Dimiccoli Hospital, Barletta, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Abate
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Rifino
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Picca
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Solarino
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000328:Adult; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Diaphysis; External fixation; Humeral fracture; Radial nerve; Safe zone