Vol. 11, Issue 4 (2025)

Background: Midshaft humerus fractures constitute approximately 3% of all fractures and frequently require operative management when conservative treatment fails or when early functional recovery is desired. Although both the anterolateral and posterior approaches are widely used for open reduction and internal fixation (ORIF), the superiority of one technique over the other remains debated. Critical variables such as radial nerve exposure, operative ease, biomechanical stability, range of motion (ROM), and functional outcome scores influence the choice of surgical approach. The Disabilities of the Arm, Shoulder, and Hand (DASH) Score and the Mayo Elbow Performance Index (MEPI) Score are validated tools for assessing postoperative upper-limb function.

Methods: A prospective, comparative observational study was conducted over two years at a tertiary healthcare center in Maharashtra, India. Forty adults aged 18–40 years with closed midshaft humerus fractures (AO types 12A.1, 12A.2, 12A.3, 12B.1, 12B.2) were included and randomly allocated to two groups: anterolateral approach (n = 20) and posterior approach (n = 20). ORIF was performed using DCP or LCP plates. Patients were followed for a minimum of 6 months. Outcomes assessed included elbow ROM, DASH and MEPI scores, intraoperative and postoperative complications, and radiological union evaluated with an adapted RUST scoring method. Statistical analysis compared functional and radiological outcomes between groups.

Results: Baseline demographic variables were comparable between groups. At 3 and 6 months, the posterior approach demonstrated significantly better DASH scores (33.4±4.6 vs 38.5±5.2 at 3 months; 23.3±3.7 vs 28.1±4.8 at 6 months) and higher MEPI scores (76.9±7.2 vs 72.6±6.5 at 3 months; 88.2±5.8 vs 83.4±7.1 at 6 months). The posterior approach group achieved greater elbow flexion, improved forearm rotation, and reduced extension lag. Complication rates were low and comparable; however, implant failure and nonunion occurred only in the anterolateral group. Radiological union occurred significantly earlier in the posterior approach group (13.9±2.0 weeks vs 15.2±2.3 weeks, p = 0.04).

Conclusion: Both approaches are safe and effective for managing midshaft humerus fractures. However, the posterior approach—particularly the triceps-sparing modification—showed superior functional outcomes, faster union, and fewer fixation-related complications. These findings support its preferential use in fractures requiring direct visualization or greater biomechanical stability.