A Prospective Randomized Study of Operative Treatment for Noncomminuted Humeral Shaft Fractures

Kim, Ji Wan; Oh, Chang-Wug; Byun, Young-Soo; Kim, Jung Jae; Park, Ki Chul

doi:10.1097/bot.0000000000000232

Cited by 92 publications

(78 citation statements)

References 27 publications

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“…The functional outcome achieved in our study is comparable to that in other similar studies on this topic 789101314152122). Compared to the normal opposite side used as a reference, most patients recovered their original ROM and strength.…”

Section: Discussionsupporting

confidence: 89%

“…On the other hand, the classical intramedullary nailing is minimally invasive, but it has the main drawback of potentially damaging the rotator cuff and causing shoulder impingement 1351011). The ABP is designed to combine the best features of these two techniques: therefore, it is minimally invasive and cosmetic friendly and causes minimal manipulation of vital structures 1012131415)…”

mentioning

confidence: 99%

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Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

Mahajan

Kim

et al. 2016

Clin Orthop Surg

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BackgroundTo assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers).MethodsForty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered.ResultsMost patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation.ConclusionsABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

Mahajan

Kim

et al. 2016

Clin Orthop Surg

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“…Experience has shown that this pattern is associated with a high risk of failure with regard to simple fractures3444. However, extensive studies have shown that the MIPO technique used with a bridging plate can provide adequate stability even for simple fractures6111314. In our study, all simple fractures healed with some but not much callus.…”

Section: Discussionmentioning

confidence: 45%

“…It provides adequate stability and is a safe, effective method for both comminuted and simple fractures6111314. However, the type of plate fixation that works best for MIPO is not clear.…”

mentioning

confidence: 99%

Comparison of the effect on bone healing process of different implants used in minimally invasive plate osteosynthesis: limited contact dynamic compression plate versus locking compression plate

Xue

Ding

et al. 2016

Sci Rep

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Minimally invasive plate osteosynthesis (MIPO) has been widely accepted because of its satisfactory clinical outcomes. However, the implant construct that works best for MIPO remains controversial. Different plate designs result in different influence mechanisms to blood flow. In this study, we created ulnar fractures in 42 beagle dogs and fixed the fractures using MIPO. The dogs were randomly divided into two groups and were fixed with a limited contact dynamic compression plate (LC-DCP) or a locking compression plate (LCP). Our study showed that with MIPO, there was no significant difference between the LCP and the LC-DCP in terms of fracture fixation, bone formation, or mineralization. Combined with the previous literature, we inferred that the healing process is affected by the quality of fracture reduction more than plate selection.

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“…The risk of bias of the included non-RCTs evaluated with the Newcastle–Ottawa Scale score is demonstrated in Table 1. Ten RCTs [10,11,13,16,18,19,21–23,25] and 7 prospective studies [12,14,15,17,20,24,26] were included, and a summary of their characteristics is presented in Table 2. These studies were published between 2000 and 2015.…”

Section: Resultsmentioning

confidence: 99%

A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures

et al. 2016

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Background:The optimal surgical procedure for humeral shaft fractures remains a matter of debate. We aimed to establish the optimum procedure by performing a Bayesian network meta-analysis.Methods:PubMed, EMBASE, the Cochrane Library, and Medline were searched for both randomized controlled trials and prospective studies of surgical treatment for humeral shaft fractures. The quality of the included studies was assessed according to the Cochrane Collaboration's “Risk of bias”.Results:Seventeen RCTs or prospective studies were included in the meta-analysis. The pooled results showed that the occurrence rate of radial nerve injury was lowest for minimally invasive plate osteosynthesis (MIPO; SUCRA probability, 95.1%), followed by open reduction and plate osteosynthesis (ORPO; SUCRA probability, 29.5%), and was highest for intramedullary nailing (IMN; SUCRA probability, 25.4%). The aggregated results of pairwise meta-analysis showed no significant difference in radial nerve injury rate when comparing ORPO versus IMN (OR, 1.92; 95% CI, 0.96 to 3.86), ORPO versus MIPO (OR, 3.38; 95% CI, 0.80 to 14.31), or IMN versus MIPO (OR, 3.19; 95% CI, 0.48 to 21.28). Regarding the nonunion, SUCRA probabilities were 90.5%, 40.2%, and 19.3% for MIPO, ORPO, and IMN, respectively. The aggregated results of a pairwise meta-analysis also showed no significant difference for ORPO versus IMN (OR, 0.83; 95% CI, 0.41 to 1.69), ORPO versus MIPO (OR, 2.42; 95% CI, 0.45 to 12.95), or IMN versus MIPO (OR, 2.49; 95% CI, 0.35 to 17.64).Conclusion:The current evidence indicates that MIPO is the optimum choice in the treatment of humeral shaft fractures and that ORPO is superior to IMN.

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A Prospective Randomized Study of Operative Treatment for Noncomminuted Humeral Shaft Fractures

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 92 publications

References 27 publications

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

Comparison of the effect on bone healing process of different implants used in minimally invasive plate osteosynthesis: limited contact dynamic compression plate versus locking compression plate

A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures

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