Humeral shaft fractures account for 1–3% of adult fractures and 20% of humerus fractures. These fractures can be treated either conservatively or surgically. Over recent years, the indications for surgical management have broadened, yielding favorable outcomes. However, plate fixation presents certain risks, including radial nerve palsy, infection, and nonunion. The literature reports varying postoperative complication rates depending on the surgical approach.

Our hypothesis was that the anterolateral approach would result in fewer postoperative radial nerve palsy and other complications than the posterior approach.

We conducted a retrospective, single-center, comparative study on plate fixation of recent humeral shaft fractures between January 2015 and January 2023. A total of 72 adult patients were included, with a minimum follow-up of one year. Two groups were formed based on the surgical approach: anterolateral (50 patients) and posterior (22 patients).

Postoperative radial nerve palsy occurred in 18% of cases—9% in the posterior approach group and 22% in the anterolateral approach group—with no statistically significant difference between groups (p = 0.32). Complications and/or reoperations were observed in 10% of cases, with a rate of 14% in the posterior approach group and 8% in the anterolateral approach group (p = 0.67) at a mean follow-up of 49 months.

This study highlights a high rate of iatrogenic radial nerve palsy following humeral shaft plating, regardless of the approach used. Emphasis should be placed on the use of anatomical approaches and longer incisions to minimize nerve injury and improve surgical outcomes.

IV; Retrospective Comparative Study.