Anteromedial Plating for Humeral Shaft Fractures: A Systematic Review and Meta-Analysis

Abstract

Abstract

Introduction: Humeral shaft fractures make up to 5% of all bony fractures. Operative treatments for humeral shaft fractures may be preferred for its lower rate of delayed union, and can be indicated in multiple fractures, open fractures, and compartment syndrome. Currently, the gold standard of operative treatment for humeral shaft fractures is by open reduction and internal fixation (ORIF), with the classic anterolateral or posterior plating. However, the use of medial or anteromedial plating may lower the risks of nerve injury, offers a smoother surface for better contact with the humerus, causing less bleeding during surgery, and has comparable outcomes with anterolateral plating. This study aims to evaluate the efficacy and safety of anteromedial plating compared to the traditional anterolateral approach.

Methods: A literature search was conducted across four databases (PubMed, Cochrane, Medline and Clinical Key) from inception to the 1st of April 2026 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Eligible studies include randomized controlled trials (RCTs) and cohort studies. Studies will be included if they involve surgical interventions of humeral shaft fractures, and reported on the treatment outcomes of the anteromedial and the anterolateral approach for humeral shaft fractures. Case reports, case-control studies, reviews, systematic reviews, meta-analyses, surveys, editorials, opinion pieces, in vitro or in vivo studies were excluded. Statistical analysis was performed using Review Manager 5.4 with inverse variance, random effects model to obtain pooled estimates of relative risks. Study quality was individually assessed using Newcastle-Ottawa Scale for Cohort Studies (NOS) and Cochrane Risk Of Bias 2.0 for RCT studies.

Results: A total of four RCTs and four cohort studies comprising 1,040 patients with proximal to middle third humeral shaft fracture were included in the meta-analysis. Anteromedial plating was associated with shorter duration of surgery (MD –4.09, 95% CI –7.33 – –0.96 minutes) and less intraoperative blood loss (MD –27.09, 95% CI –47.88 – –6.29 milliliters) compared to anterolateral plating. Radial nerve injury is generally less in the anteromedial group, with significant differences reported in the cohort studies (RR 0.13, 95% CI 0.03 – 0.53). No significant difference in time to union and non-union was observed between groups. Functional outcomes were excellent with full ROM in 98–100% of patients in the anteromedial group. Risk of bias assessment revealed some concerns due to inability to blind surgeons in RCTS, while cohort studies exhibited moderate bias regarding patient selection and comparability. Primary limitations were limited number of long-term studies, high heterogeneity, likely due to variations in surgical and incision techniques, and lack of standardized functional outcome scores across studies.

Conclusion: This systematic review and meta-analysis suggested that anteromedial plating for humeral shaft fractures demonstrates comparable clinical outcomes to anterolateral plating. Anteromedial plating was consistently associated with a statistically significant shorter operative duration and reduced intraoperative mean blood loss. High heterogeneity in intraoperative metrics and the limited number of good-quality studies suggest that further high-quality trials are necessary to confirm these advantages.

Keywords: humeral shaft fracture, medial plating, anteromedial plating