Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?

Abstract

Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion.

Humeral shaft fractures

“…Potential drawbacks include brachial scarring and subsequent loss of elbow motion, difficulty obtaining an adequate reduction and resultant increase in radiation exposure and operative time, and risk of nerve injury with percutaneous screw placement [34•]. Recent studies evaluating outcomes of MIPO plating have been favorable [33,35]; however, more prospective studies will be necessary before wide-spread use is recommended.…”

“…Three screws are then placed on each side of the fracture. This method protects the radial nerve and preserves fracture site biology [33]. Potential drawbacks include brachial scarring and subsequent loss of elbow motion, difficulty obtaining an adequate reduction and resultant increase in radiation exposure and operative time, and risk of nerve injury with percutaneous screw placement [34•].…”

Técnica Mínimamente Invasiva por vía posterior para el Tratamiento de Fracturas Diafisarias del Húmero. Posterior minimally invasive plate osteosynthesis for humeral shaft fractures

“…Concha y cols. 30 describieron los resultados de 35 pacientes con fracturas diafisarias tratadas con TMI, 15 de ellos tenían fracturas expuestas. La consolidación se obtuvo en el 91% de los casos.…”

“Comparative Study of Functional Outcome of Dynamic Compression Plating and Interlocking Nailing For Fracture Shaft of Humerus in Adults”

“…The second most common cause is fall on outstretched hand , which is an indirect injury especially in the geriatric group 1-4. Most fractures were conservatively treated except for those who had the indications. The surgical indications are: Unacceptable reduction of fractures, radial nerve palsy, associated vascular lesions, open fractures, polytrauma patients, floating elbow ,obese patients who may develop varus angulations [1][2][3][4][5] . Among surgical options , open reduction and fixation with plate and screw, is the gold standard, because of shorter time to union and lesser complications, when compared to intra medullary nailing.…”

“…Among surgical options , open reduction and fixation with plate and screw, is the gold standard, because of shorter time to union and lesser complications, when compared to intra medullary nailing. [1][2][3][4] The soft tissue violation is a major disadvantage of plating over nailing, thus less invasive measures like indirect reduction and percutaneous plate fixation has been developed. A simple, effective and safe treatment , is anterior plating for nonunion of humeral shaft fracture.…”