Fracture humerus comprises approximately 3% of all fractures of human body. Although most of them can be managed conservatively with good functional results, maintenance of limb length, rotational and angular correction and early joint mobilization are the matter of concern[1]. Also this type of treatment generally does not assure union in every case. Improper immobilization and distraction due to muscular forces are the common causes of non union in them[2-3]. To overcome these problems operative techniques for fixation of humeral fractures came into notice. These include close intramedullary nailing and open plating[4].

Intramedullary nailing has got all the advantages of close nailing techniques, including lesser tissue destruction and prevention of periosteal blood supply[5-6]. But it is associated with complications of joint stiffness, greater tuberosity fracture, and damage to radial nerve in certain fractures. Rotational malunion and non-union due to fracture distraction are common. Also nailing damages endosteal blood supply.

Plate osteosynthesis is now regarded as the gold standard technique for management of humeral shaft fractures. Although it has got its own disadvantages like blood loss, tissue damage and long surgical scar, the benefits overshadow these drawbacks. Anatomical reduction and interfragmentary compression assures stable fixation without violation of rotator cuff. It provides early restoration of muscle and joint function and return to normal work[7]. Radial nerve can be visualized, freed and separated in required cases and bone grafting can be done in the same setting to enhance fracture fixation. It is also beneficial in multiply injured patients as it allows early mobilization of extremity. Exposure risk of the medical staff to the image intensifier is decreased. All this accounts for universal acceptance of this technique as the procedure of choice in treating humeral shaft fractures[8-9].

Study Design: Observational Study

A detailed history was obtained regarding mechanism of injury, associated injuries, status of head injury, neurovascular damage, post rehabilitation physical demands of patient, drug abuse and any mental illness.

A midline incision was given over posterior aspect of the arm. Extension depended upon the location & length of fracture. Triceps fascia was incised and dissected laterally to the intermuscular septum, it was carried proximally. Radial nerve was identified, freed and separated away from the bone. Triceps muscle was separated and care was taken not to damage the periosteum excessively. Fracture fragments were identified, curetted and aligned (fracture reduction). These fragments were then held together and plate was attached to them by plate holding forceps. Plate was contoured as and when required.

INCLUSION CRITERIA

1. Participants willing to be part of the study.
2. All adult patients presenting with displaced diaphyseal fracture of shaft humerus 5cm proximal and distal to metaphysis.
3. Age group of 18-60 years.
4. Closed fractures.
5. Failure to obtain and maintain adequate close reduction.

EXCLUSION CRITERIA

1. Pathological fractures.
2. Segmental fractures.
3. Poor skin condition.
4. Any medical contraindication to surgery.
5. Patients unwilling to participate in study

PREOPERATIVE EVALUATION

Patients were assessed with detailed history, clinical and radiological evaluation, in order to select them for this study and to rule out any concomitant injuries of shoulder girdle, elbow or other body parts which can have deleterious effect on fracture healing and functional outcome postoperatively. Although fractures of single forearm bone, metacarpels, phalanges and clavicle were included in the study; both bone injuries and major ipsilateral limb trauma were excluded

Table No. 1: Age Distribution

Patients belonging to age groups between 18 to 60 years were included in the study with most of them (63.3%) falling in second and third decade of their life. Average age was 36 years, youngest and oldest patients were of 20 & 55 years respectively

Table No. 2: Side affected

Out of the thirty patients included in the study, fractures involving the left humerus were more frequent (53.3%) in presentation as compared to the right one (46.7%). No obvious cause for this finding can be traced.

Table No. 3: Cause of injury

Road traffic accidents accounted for the major chunk of patients suffering from fracture humerus (22 out of 30) as compared to fall and assault (8 cases).

Table No. 4: Complications

 Superficial infection was dealt with regular dressings and delayed suture removal. Patients having nonunion and screw back out denied to any secondary surgery. There were three cases of radial nerve palsy (2 preoperative, 1 postoperative), two of them recovered gradually and one is still under follow up

Concepts regarding trauma management in orthopaedics are rapidly changing to keep pace with the increasing severity and complexity of fracture presentations. As knowledge about this science is increasing, there is an obvious drift towards internal fixation techniques for fracture stabilization as compared to non-operative conservative type of treatment. It reduces chances of malunion, nonunion, angulation & shortening[10]. The same holds true for humeral fractures too. Recent studies have identified a higher rate of nonunion and deficits of shoulder & elbow function in patients being treated conservatively. These fractures should therefore be viewed as a spectrum of injuries with diverse functional outcomes, each requiring careful assessment and individualized treatment.

Various techniques have been proposed for fracture fixation and accordingly argued with their merits and demerits. Out of them intramedullary nailing and open reduction plate fixation are two commonly used methods[11]. Although comparative radiological results are found with intramedullary nailing techniques, the area where it lags behind is the overall functional outcome and patient satisfaction especially in the physically active individuals. It has been shown that fracture union is better with plating techniques due to proper compression of fracture fragments. Implant removal is generally not required[12].

This study was carried to find out the efficacy of plating techniques in treating fractures of humeral shaft, to compare its outcome with other similar studies done in past and to arrive at a point to conclude whether this technique has got an upper hand in fracture fixation of humeral shaft or not[13-14].

Left humerus was found to be more commonly fractured as compared to the right one in all the studies. In our study the ratio was 16:14 for right and left side respectively. In our study, majority of fractures, 17 out of 30 were found in the middle third of humerus & 56.7% of patients were plated for this,

30 patients of diaphyseal fracture humerus were treated with open reduction and internal fixation using plate osteosynthesis technique. All of them were evaluated periodically, clinically and radiologically. Average age of patients was 36 years, with maximum number of patients in age group of 20-40 year (19). Left humerus 16(53.3%) was commonly fractured than right one 14(46.7%). Road traffic accidents were the most common cause of injury, as seen in 22 (73.3%)  patients

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