Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus

Zhao, Wei; Qü, Wei; Fu, Chongyang; Jiang, Haiyue; Liu, Sida; Cheng, Chao

doi:10.1007/s00264-017-3514-2

Cited by 17 publications

(10 citation statements)

References 25 publications

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“…3 In recent randomized controlled trials, operative management showed better outcomes compared to functional bracing in the treatment of humeral diaphyseal fractures including distal third humeral shaft fractures. 4,5 To address the surgical treatment of distal diaphyseal humeral fractures, several approaches can be used, [6][7][8][9][10] depending on the fracture features or status of the patient. If the fracture line is extended to or over the metaphysis, limited bone stock would be available for sufficient screw fixation via a conventional anterolateral approach.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Lim

Yoon

Choi

et al. 2020

Journal Orthopaedic Research

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The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: the modified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

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Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Lim

Yoon

Choi

et al. 2020

Journal Orthopaedic Research

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“…The most frequent cause of iatrogenic nerve injury is interruption of the nerve continuity during surgery or medical procedure [ 19 ]. Zhao et al [ 20 , 21 ] emphasized that precision for the exploration of the radial nerve was essential to avoid nerve iatrogenic injuries. How to achieve radial nerve exposure remains a challenge for the orthopaedic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

Liu

Wang

et al. 2022

BMC Musculoskelet Disord

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Background The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve. Methods Between May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups. Conclusions The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.

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“…The most frequent cause of iatrogenic nerve injury is interruption of the nerve continuity during surgery or medical procedure [19]. Zhao et al [20,21] emphasized that precision for the exploration of the radial nerve was essential to avoid nerve iatrogenic injuries. How to achieve radial nerve exposure remains a challenge for the orthopaedic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided Preoperative Localization of Radial Nerve in the Treatment of Extra-articular Distal Humeral Shaft Fractures

Liu

Wang

et al. 2021

Preprint

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Background: The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.Methods: Between May 2014 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. 28 patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results: A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (p < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (p < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (p < 0.001) and iatrogenic radial nerve palsy rate (0 vs 10.7% ) (p< 0.001). However, the fracture union time (13.52 months vs 12.96 months) (p = 0.796) and the MEPS sscore (87.56 vs 86.38) (p = 0.594) were no significantly different in both groups. Conclusion: The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the incidence of iatrogenic radial nerve injury and the intraoperative bleeding volume. In addition, it has the advantages of operability, safety, efficiency and repeatability.

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Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus

Abstract: Level IV, case series, treatment study.

Cited by 17 publications

References 25 publications

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures

Ultrasound-guided Preoperative Localization of Radial Nerve in the Treatment of Extra-articular Distal Humeral Shaft Fractures

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