Humeral shaft fractures are prevalent for trauma patients. Surgeons usually utilize open reduction and internal fixation (ORIF) with plates and screws to treat humeral mid-shaft fractures. Humeral mid-shaft fractures are typically treated through posterior or anterolateral approaches. It is reported that ORIF via posterior approach is associated with as high as 11.5% of subsequent iatrogenic radial nerve palsy. In contrast, the anterolateral approach has a relatively lower incidence of iatrogenic radial nerve injury. However, few studies have compared the functional outcomes and complications of the posterior and anterolateral surgical approaches as far as we know.

To compare the functional results and complication rates between anterolateral and posterior approaches in treating humeral mid-shaft fractures.

This study included 177 patients diagnosed with humeral mid-shaft fractures and surgically treated through anterolateral or posterior approaches from January 2015 and July 2019. We collected the demographic and operation data for each patient. During follow-up visits, radiographs were acquired and evaluated. At the 12-month follow-up, the functional results of the affected elbow and shoulder were evaluated with Mayo Elbow Performance Score (MEPS) , Constant score, and range of motions (ROMs) .

The anterolateral approach was performed in 86 patients with type A fractures (group Ⅱ, n=51) and type B or C fractures (groupⅣ, n=35) . The posterior approach was performed in 91 patients with type A fractures (groupⅠ, n=45) and type B or C fractures (group Ⅲ, n=46) . No significant differences were found between groupⅠand groupⅡor between groupⅢ and group Ⅳ in demographics, operation data, fracture union time, ROMs of the shoulder and elbow joint, Constant score, or MEPS. There was a significant difference in the overall complication rate between groupsⅠand group Ⅱ (P=0.011) .

The anterolateral approach showed an advantage over the posterior approach to treat simple humeral mid-shaft fractures. However, this advantage was not observed in the treatment of comminuted fractures.