Surgical fixation (intramedullary nail or plate and screws)
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026This guide is for people having surgery to fix a humeral shaft fracture. Fixation is used when the bone is in a poor position, when there is more than one break, when a nerve or blood vessel needs attention, or when brace treatment has not held the fracture. It explains what to expect before, during, and after the operation. (If you are being treated in a brace rather than having surgery, see the "Living in a functional brace" section on the condition page.)
Step 1, Your pre-operative assessment
ℹ️ This usually takes place 1-2 weeks before surgery. You will have blood tests, sometimes an ECG, and a review of your medications. Blood thinners and some other medicines may need to be paused, and your team will give you specific instructions on when to stop and restart them.
Fixation is performed under general anaesthetic and usually takes 45-90 minutes. The surgeon either passes a metal rod down the centre of the bone through small incisions (intramedullary nail), or fixes a metal plate to the surface of the bone with screws through a longer incision (plate fixation). The choice depends on the fracture pattern and its position. During plate fixation the radial nerve is identified and protected.
Pause blood thinners as advised
If you take warfarin, a DOAC, or other blood-thinning medicines, your team will tell you when to stop them before surgery. Do not stop any medication unless you have been told to.
Arrange help and transport
You will not be able to drive for several weeks. Arrange a lift home and some help around the house for the first week or two.
Keep the arm elevated after surgery
Resting with the hand raised above the level of the elbow reduces swelling and helps the wound heal, particularly in the first 1-2 weeks.
Start gentle movement early
Because the fracture is now held by the implant, gentle shoulder and elbow movement usually begins within the first few days, guided by your physiotherapist. Fixation generally allows earlier movement than brace treatment.
Watch for wrist drop
The radial nerve runs close to this bone and can be affected by the injury or, rarely, the surgery, causing temporary weakness lifting the wrist and fingers. This usually recovers over 3-4 months. Tell your team if you notice it.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Contact your team urgently if the wound becomes increasingly red, hot, swollen, or starts to discharge, if pain worsens rather than settling, or if you develop new weakness or numbness in the hand.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
The operation
Fixation with a nail or plate under general anaesthetic. Most patients stay one night, though some go home the same day.
Wound and early movement
Keep the wound clean and dry and the arm elevated. Gentle shoulder and elbow movements begin as advised. Pain is managed with regular analgesia.
Building movement
Stitches or clips are removed around 2 weeks. Range-of-movement exercises progress under physiotherapy. An X-ray checks the fixation and healing.
Strengthening
As healing is confirmed on X-ray, strengthening exercises are added. Many people return to driving and lighter work during this period.
Full recovery
Strength continues to return and most activities resume. Any radial nerve recovery continues.
Will I need a brace as well?
Usually not. The purpose of fixation is that the implant holds the bone, so a brace is generally not needed afterwards and you can start gentle movement earlier. Your team will tell you if a sling is needed for comfort in the first week or two.
Nail or plate, which will I have?
It depends on the fracture. A nail is passed down the inside of the bone through small incisions and suits certain mid-shaft patterns; a plate is fixed to the surface through a longer incision and lets the surgeon see and protect the radial nerve directly. Your surgeon will explain which is planned for you.
What about wrist drop?
Weakness lifting the wrist and fingers (wrist drop) usually comes from the radial nerve being stretched at the time of the injury. It affects around 1 in 10 humeral shaft fractures, and most recover on their own over 3-4 months. During plate fixation the nerve is identified and protected.
Will the metalwork need removing?
Usually not. A nail or plate is generally left in place permanently. It is only removed later if it causes irritation or other problems, which is uncommon.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
The aim of surgical fixation is to achieve stable anatomical alignment of the fracture, allowing earlier mobilisation than bracing, and to address any associated injuries (open fracture, radial nerve palsy requiring exploration, or polytrauma).
What the procedure involves
Intramedullary nail: through a small incision at the shoulder (antegrade) or elbow (retrograde), a metal nail is passed down the medullary canal of the humerus and locked with screws above and below the fracture. Plate fixation: through a longer incision on the arm, the fracture is exposed, reduced, and secured with a plate and screws applied to the outer surface of the bone. The radial nerve is identified and protected throughout the procedure. Both take approximately 60-90 minutes under general anaesthetic.
Alternative treatments
Functional (Sarmiento) bracing
The standard non-operative treatment for most humeral shaft fractures. A functional brace is applied at 1-2 weeks and worn for 8-12 weeks. Effective in over 90% of appropriate fractures.
Cast immobilisation
Used initially; usually replaced by functional brace at 1-2 weeks once swelling has settled.
Intramedullary nail
Compared with plate fixation, associated with higher rates of shoulder pain but a smaller incision. Preferred for more proximal fractures.
Plate fixation
Provides more rigid fixation and direct access for radial nerve exploration. Preferred for spiral and transverse fractures and where nerve exploration is needed.
Risks of the procedure
The radial nerve is at risk during the surgical approach, particularly with plate fixation through the posterior approach. A new post-operative radial nerve palsy (wrist drop) occurring after surgery requires careful monitoring and may require further exploration.
Failure of the fracture to heal, most commonly at the fracture site. May require further surgery (bone grafting and revision fixation).
Wound or deep bone infection. May require implant removal and prolonged antibiotic treatment.
Screw breakage or plate/nail failure, usually from excessive loading before healing is complete.
Particularly with intramedullary nailing (shoulder pain) and after prolonged immobilisation.
Expected and managed with regular analgesia.
Normal after humeral surgery.
Local sensory nerves may be affected by the incision. Usually resolves.
The arm is in a sling initially after surgery. Active use is gradually increased.
If you choose not to have surgery
The vast majority of humeral shaft fractures heal successfully without surgery using a functional brace. Surgical fixation is generally reserved for specific indications (open fractures, polytrauma, radial nerve exploration, and fractures failing bracing). Proceeding to surgery when bracing is appropriate increases the risk of complications without improving the outcome.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is a humeral shaft fracture?
It is a break in the main shaft of the upper-arm bone, usually after a fall or a direct blow.
Your choiceDo I need surgery?
Many humeral shaft fractures heal without surgery, often supported in a functional brace. Surgery, using a plate or rod, is considered for certain patterns, multiple injuries, or if the bone is not healing. Your surgeon will advise on the best option for you.
Getting backHow long does recovery take?
Bone healing commonly takes around 8 to 12 weeks or more, with strength and function returning over the following months. A brace allows the nearby joints to keep moving while the bone heals.
Wrist nerveWhy is my wrist or hand weak?
The radial nerve runs close to this bone and can be stretched by the fracture, causing temporary weakness lifting the wrist and fingers (sometimes called wrist drop) or numbness on the back of the hand. This often recovers over weeks to months; your team will monitor it and may use a splint.
Pain & medsHow do I manage pain?
Pain relief together with support from a brace or sling. Keep the hand, wrist and shoulder moving as advised to limit stiffness.
UrgentWhen should I seek urgent help?
New weakness lifting the wrist or fingers, numbness on the back of the hand, a cold or pale hand, severe swelling, or signs of wound infection after surgery all need prompt review.
WellbeingThe long recovery is getting me down.
That is understandable with a fracture that heals slowly. Tracking small gains and keeping the nearby joints moving helps; contact your team with any concerns.
- NHS: Broken arm or wrist
- British Elbow & Shoulder Society: early exercises and sling care
- British Elbow & Shoulder Society: patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.