These are fractures of the diaphyseal segment of the humerus. As a whole, they represent the 1.6% of the total number of surgically treated fractures.

The classic textbooks indicate conservative treatment for the fractures of this humeral segment and, for several reasons, it still is a valid indication nowadays, especially for the complex fractures of the group C. These fractures are easy to align, slight shortenings or rotational malalignments do not result in significative functional impairment, healing is fast and surgery has the added risk of the radial nerve pathway.

There is, however, an increasing social pressure for confort and earlier function. External immobilizations of whatever type are allways a nuisance, insufficient and many times completely ineffective, delaying a surgery that could have been immediate. This is so not only for young patients with labor or sports issues but also for elder patients and obese women with large breasts, for which the conservative treatment represents a torture prolonged for weeks, and sometimes months. A major part of the surgery of this segment is related to delayed unions and pseudoarthrosis.

The traditional surgical treatment is the multiple intramedullary nailing as proposed by Hackethal, a technique of uncertain results that depend on the indication, the performance of the technique and the cooperation of the patient. Several intramedulary implants giving better stability than the classic multiple nailing have recently become available but, in optimal conditions of patient, surgeon, instruments and hospital, internal fixation with a plate gives the best results.