Indications for operative treatment include inability to obtain or maintain adequate reduction, multiple injuries, delayed union, and neurovascular injuries.
In the majority of patients with proximal and distal fractures, plating is the most reliable operative technique for achieving satisfactory union.
Intramedullary nails are the best option for pathological or impending pathological fractures of the humeral shaft.
Proximal humeral shaft fractures require a device which can provide a good hold in the small proximal fragment, which consists mainly of the humeral head. The PHILOS plate achieves this, as do some modern humeral nailing systems with proximal locking options. The choice is based on the surgeon’s preference.
Open fractures require different procedures depending on the severity of the soft-tissue injury. More severe types of open fractures (ie type III) should be fixed with an external fixator temporarily and a primary fixation with a nail or plate is contraindicated.