Effects of different surgical techniques on mid-distal humeral shaft vascularity: open reduction and internal fixation versus minimally invasive plate osteosynthesis

Abstract

BackgroundHumeral shaft fractures are generally managed with the conventional posterior open reduction and internal fixation (ORIF) or minimally invasive plate osteosynthesis (MIPO). This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of the mid-distal humeral shaft.MethodsTwelve upper limbs were harvested from 6 fresh cadavers. ORIF or MIPO was randomly performed on either side of each pair of limbs. The axillary artery was perfused with a latex-lead tetraoxide red solution to visualize the vascular structures. The vascular integrity of the humerus was examined by plain radiography and dissection. The periosteal filling achieved with each technique was scored and the scores compared.ResultsIn each limb, one main nutrient artery entering the mid-distal humeral shaft anteromedially (83.3 %) or medially (16.7 %) was first identified. No case of injury to the main nutrient artery was noted for either surgical technique. Injuries to the accessory nutrient arteries entering the mid-distal humeral shaft from the posterior aspect were absent in the MIPO cases, but occurred in 52.9 % of the ORIF cases. In addition, MIPO was also superior to the open plate technique showed superior periosteal filling than.ConclusionsOur results showed that the MIPO technique is superior to the ORIF in terms of preserving the vascular integrity of the mid-distal humeral shaft.

A 3‐dimensional‐printed patient‐specific guide system for minimally invasive plate osteosynthesis of a comminuted mid‐diaphyseal humeral fracture in a cat

“…The development of minimally invasive plate osteosynthesis (MIPO) has been driven by an increasing awareness of the importance of fracture site biology to bone healing . Preservation of local vascularity is a key principle and is maximized by reduced dissection at the fracture site and preservation of the fracture hematoma . When mechanically appropriate, this biological approach has led to an evolution in fracture management from open, direct fracture reduction through open, indirect reduction techniques (such as open but don't touch) to closed, indirect reduction .…”

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures

“…The use of MIPO technique is gradually increasing not only for the treatment of humeral shaft fractures but also for other fractures since it facilitates bone healing process by preserving the biological environment of fracture sites and the technique is easy to perform. 10) Conservative management used to be the gold standard for the treatment of humeral shaft fractures. Lately, however, the use of operative treatment is increasing for rapid return to daily life.…”

Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient

“…This was recently compared to traditional open reduction internal fixation in a large series of mid-distal humerus fractures, with findings of shorter union time and equivalent complication rates in the MIPO group. [56][57][58]…”