How to treat proximal and middle one-third humeral shaft fractures: the role of helical plates

Purpose: To evaluate the outcomes of patients affected by proximal and middle one-third humeral shaft fractures treated with humeral helical plates. Material and methods: From October 2016 to June 2020, twenty-four (twenty women, four men) underwent humeral reduction and fixation with humeral helical plates (A.L.P.S.® Proximal Humeral Plating System, Zimmer Biomet) that preserve deltoid muscle insertion and reduce the risk of iatrogenic radial nerve injury. At one and six months after surgery, standard antero-posterior and lateral radiographs were obtained, and at last follow-up (eighteen months on average), clinical evaluation was performed through range of motion assessment, Constant score and DASH score questionnaires. Only descriptive statistical analysis was conducted. Results: At six months, all fractures have healed. At last follow-up (average eighteen months, 13–28) mean Constant score was 71 (range 33–96), mean Dash score was 19.2 (range 1.7–63). The average range of motion was calculated as follows: flexion 137.8° (range 90–180); abduction 125.8° (range 85–180°); external rotation 55° (range 20–80°), internal rotation at L3 (range between scapulae-trochanter). Three patients experienced temporary radial nerve palsy from injury, while in one case, a temporary iatrogenic palsy occurred. Conclusions: In our opinion, the helical plate may be an effective surgical tool for management of proximal and middle one-third diaphyseal humeral fractures. The humeral helical plate allows stable fixation avoiding the deltoid tuberosity proximally and radial nerve distally, thus increasing the possibility of rapid functional recovery after surgery. © 2022, The Author(s), under exclusive licence to Istituto Ortopedico Rizzoli.