The management of gunshot fractures of the humerus.

We report 37 patients who were treated for gunshot fractures of the humerus during a 6 month period at the ICRC hospital, Lopiding, on the Sudanese border. Initial treatment followed the established principals for war surgery. The strategy for fracture stabilization however remains controversial. External fixation has been widely used in war surgery. This paper compares the different methods of stabilization for humeral fractures available in a field hospital. Fracture healing was delayed after external fixation and infection persisted longer than with the other methods of immobilization such as skeletal traction, functional bracing and 'collar and cuff' support. In the author's experience, external fixation has no advantage over non-operative methods for comminuted gunshot fractures of the humerus, unlike its use on the lower limb. The best results for fracture healing and final function were achieved by functional bracing.