Operative management of diaphyseal fractures of the humerus. Plate versus nail.

Although nonoperative treatment is indicated and successful for the majority of diaphyseal humeral fractures, operative intervention is indicated in several situations. Either intramedullary nail or plate fixation commonly is used for the operative management of this problem. Familiarity with the surgical techniques and application of both types (and subtypes) of implants is necessary to allow optimal treatment for the widest range of fracture patterns. In most indications for operative management, internal fixation with plates is preferred. Stable fixation, sparing adjacent joints from iatrogenic injuries, and direct visualization and protection of the radial nerve are of critical importance in maximizing postoperative function and in most cases outweight the potential advantages of a loadsharing implant inserted through a more limited incision.