Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study

Abstract

The aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus. Material/Methods: This study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up. Results: The posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II. Conclusions: The anterolateral approach showed an advantage over the posterior approach for treating simple humeral midshaft fractures. However, this advantage was not observed in treating comminuted fractures.

The risk of iatrogenic radial nerve and/or profunda brachii artery injury in anterolateral humeral plating using a 4.5 mm narrow DCP: A cadaveric study

“…The radial nerve and profunda brachii artery cross the posterior humerus obliquely from the medial to the lateral sides [ 6 – 8 ]. There is a chance of iatrogenic radial nerve injury in either the anterolateral or the posterior humeral shaft plating, with incidences of between 3.57% and 18.20% [ 9 – 11 ]. Previous studies have reported the incidence of radial nerve palsy in the anterolateral plating was similar to the posterior plating, but significantly higher only in one study [ 4 ].…”

“…Previous studies have reported the incidence of radial nerve palsy in the anterolateral plating was similar to the posterior plating, but significantly higher only in one study [ 4 ]. The posterior plating can endanger the radial nerve and/or profunda brachii artery by plate compression or accidental injury during surgical exposure while the anterolateral plating can injure the radial nerve and/or profunda brachii artery while drilling the screw holes and/or inserting the screws [ 9 ].…”

“…The radial nerve and profunda brachii artery could have been injured during the trauma that caused the fracture, or they could be injured during the fixation from drilling the screw holes or inserting the screws [ 2 – 5 ], as these structures are located on the posterior aspect of the humeral shaft, crossing the humerus obliquely from the posteromedial to the posterolateral sides, but their precise location cannot be known by the surgeon performing the fixation and drilling screw holes and inserting screws [ 6 – 8 ]. Earlier studies have reported incidences of radial nerve injury during surgical fixation ranging from 3.57% to 18.20% [ 9 – 11 ].…”

“…The posterior plating is more suitable for mid- to distal shaft humerus fractures, while the anterolateral plating is more suitable for proximal to mid-shaft humerus fractures. There have been three studies comparing the anterolateral and posterior plating in humeral mid-shaft fixation [ 9 – 11 ], in all of which both plating had excellent outcomes in union rate, range of shoulder and elbow motions, and functional scores. The complication of iatrogenic radial nerve palsy in most studies were similar between the two locations of the plate which the incidence were 3.57–14.20% in the anterolateral plating and 16.67–18.18% using the posterior plating.…”

“…These plates are applied to the humerus in different locations, and thus the trajectory of the screws is also different. The 4.5 narrow DCP is commonly applied at the anterolateral surface of the humerus ( Fig 1 ) [ 9 – 11 , 24 ], while the 4.5 mm narrow LCP can be applied at either the mid-anterior aspect ( Fig 2 ) or the anterolateral surface [ 21 , 25 , 26 ]. The direction of the screws while applying the plate at the anterolateral surface is from the anterolateral aspect of the humerus to the posteromedial aspect, while the direction of the screws while applying the plate at the mid-anterior aspect of the humerus is from the mid-anterior to the mid-posterior area of the humerus.…”