Safety and Efficacy of Conversion from External Fixation to Plate Fixation in Humeral Shaft Fractures

Objective: Immediate external fixation and planned conversion to internal fixation of humeral shaft fractures is an option in the treatment of associated severe soft-tissue injuries and severely injured patients. The purpose of this study was to evaluate the outcome and complications of patients who sustained humeral shaft fractures and were treated with initial unilateral external fixation followed by plate fixation. Design: Retrospective analysis of a prospective database. Setting: Academic level I trauma center. Patient/Participants: We identified 17 patients treated between June 2003 and August 2007 with immediate unilateral external fixation followed by planned conversion to internal plate fixation. All patients were seen for follow-up until bony union occurred, with a minimum follow-up of 6 months. Main Outcome Measurements: Initial patient condition, local and systemic complications, and short-term outcomes were evaluated. Results: The main reason for immediate placement of an external fixator was multiple trauma in nine patients (damage control orthopedics group); six open fractures with massive soft-tissue injury; one temporarily decreased perfusion to the forearm and hand; and one associated compartment syndrome of the upper arm. The average timing of the conversion to internal fixation was 6.2 (range, 2-14) days from the time of external fixation. There were no iatrogenic nerve injuries after either the external fixation or the conversion to internal fixation. Fifteen of 17 fractures united with an average time to healing of 11.1 (range, 8-14) weeks. Two fractures failed to heal after conversion from external to internal fixation. Both were open fractures from the non-damage control orthopedics group that developed a deep infection. There were no systemic complications after conversion from external to internal fixation. Conclusions: Immediate external fixation with planned conversion to plate fixation within 2 weeks proved to be a safe and effective approach for the management of humeral shaft fractures in selected patients with multiple injuries or severe soft-tissue injuries that preclude early plate fixation.