Comparative Analysis of Anterolateral and Posterior Approaches for Distal Humerus Shaft Fractures: A Multicenter Retrospective Study

<b>Background</b>: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. <b>Methods</b>: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. <b>Results:</b> Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (<i>p</i> = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, <i>p</i> = 0.03). However, intraoperative blood loss (<i>p</i> = 0.36), Mayo Elbow Performance Score (<i>p</i> = 0.71), range of motion (<i>p</i> = 0.36), and complication rates (<i>p</i> = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (<i>p</i> = 0.17), and four cases required implant removal due to discomfort (<i>p</i> = 0.18) in the anterolateral group. <b>Conclusions</b>: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection.