Immediate plate osteosynthesis of open fractures of the humeral shaft.

Background: The aim of this study was to assess the outcome of immediate plate osteosynthesis in the surgical treatment of open humeral shaft fractures. Methods: In a Level I trauma center and teaching hospital, we reviewed 53 patients with open humeral diaphyseal fractures who were treated with immediate open reduction and plate fixation from April 1988 to August 1998. Forty-six patients were available for adequate follow-up and assessment. All fractures were treated with a standard protocol that included irrigation and debridement, intravenous antibiotics, and immediate open reduction and plate fixation. Patients were assessed to determine whether bone grafts were needed during surgery, whether bone union was achieved, the state of the radial nerve, and postoperative complications. No quantitative functional outcomes were assessed, because this was beyond the scope of the study. It was hypothesized that immediate plate osteosynthesis would achieve safe and acceptable clinical results. Results: The 46 patients with adequate final follow-up were assessed at a mean time of 37.5 weeks (13-156 weeks). All fractures united primarily in satisfactory angulation <5 degrees in coronal and sagittal planes. There were 6 delayed unions with a mean time to union of 42.5 weeks (30-72 weeks). The remaining 40 patients united at a mean of 18.4 weeks (12-26 weeks). No patient required subsequent surgery to obtain union of the fracture. Complications were rare, with no deep infections, nonunions, or iatrogenic nerve injuries. Complications included amputation in three patients and dysesthesia in one patient. Two patients had implants removed because of discomfort. Conclusions: Immediate plate osteosynthesis for open humeral shaft fractures has been shown to produce excellent results regarding bone union and absence of deep infections and is a safe technique in the management of these injuries.