Fractures (breaks) of the humerus are commonly treated without an operation. The indications for surgery are not completely clear, but often include open fractures (fractures exposed to contamination through the skin) or unstable fractures such as segmental fractures (where there are two or more fractures in the same bone with a free fragment in between).
When an operation is needed the choice is usually between a plate or an intramedullary nail. Plating is achieved by exposing the fracture site, fixing a plate to the bone and securing it with screws. Intramedullary nailing is performed through small cuts in the skin. The nail is inserted to lie within the central cavity of the bone through a carefully prepared hole, usually at the top end of the humerus. Locking screws in both ends may be used to further stabilize the nail.
Five poor quality trials were included in this review. These involved a total of 260 participants who were randomly assigned to having their humerus fractures fixed with either a plate or a nail. Both nailing and plating had similar fracture union rates. Compared with plating, nailing was associated with an increased risk of shoulder impingement involving shoulder pain and restrictions in shoulder range of movement. Usually because of impingement, nails had to be removed more frequently than plates. The limited available evidence did not show important differences between the two surgical methods in the other outcomes reported by one or more trials. These outcomes included nerve injury, infection, healing time, operating time, blood loss and return to pre-injury occupation.