Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Abstract

BackgroundThe use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or open reduction and internal fixation (ORIF) in patients with proximal humerus fractures.MethodsA matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score.ResultsThe MIPO technique required less surgery time and caused less blood loss compared to ORIF (p < 0.01). In addition, MIPO required a smaller incision, resulted in less scarring, and was cosmetically more appealing and acceptable to female patients than ORIF. Following MIPO, patients had better functional results at 3 and 6 months, with better outcomes, less pain, higher satisfaction in activities of daily living, and a higher range of motion when compared to ORIF (p < 0.05). Fracture configuration, according to the AO/ASIF(Association for the Study of Internal Fixation) fracture classification, did not significantly influence the functional results. The complication rate was comparable between both groups.ConclusionThe use of MIPO with a locking compression plate in the management of proximal humerus fractures is a safe and superior option compared to ORIF.

Dynamic contrast-enhanced ultrasound (CEUS) after open and minimally invasive locked plating of proximal humerus fractures

“…Our results of the functional scores are comparable with those presented in earlier studies [15,20,22,37,38], that there were no differences between open deltopectoral reduction and fixation vs. a minimally-invasive deltoid-splitting approach. Complications were comparable with other studies in type and number [15,38,39].…”

“…Complications were comparable with other studies in type and number [15,38,39]. Hepp et al [20] and Lin et al [22] found differences in the sub-scores of the CS in a short term follow-up at three months postoperatively which we could not confirm. In our study we focused on the long-term results which are more relevant to influence patients' satisfaction and outcome.…”

“…Hence, minimally invasive plate osteosynthesis (MIPO) via the deltoid-splitting approach was introduced with the intention of minimizing soft tissue injury, shortening inpatient stay and consequently improving shoulder function [16][17][18][19]. So far, only few studies directly compared the long term results of ORIF versus MIPO approaches and clear differences could not be established with respect to shoulder function, psychosocial outcomes, patient satisfaction, and complication rates [20][21][22]. Furthermore, these studies did not systematically analyze the impact of axillary nerve lesions, which are suspected to occur more frequently in minimally invasive deltoidsplitting approaches [23,24].…”

Minimally invasive plate osteosynthesis for midshaft clavicular fractures using superior anatomic plating

“…10,12,16,23,30 In recent years, however, more and more surgeons have realized that conventional fixation methods might be the key reason for increasing complications observed in patients with fracture. 2,13 Therefore, the biological osteosynthesis concept has been developed to draw more attention to soft tissue circumstances. 17,26 In addition, numerous MIPO techniques have been designed aiming to preserve soft tissue and the periosteum blood supply at the fracture site, including femoral, tibial, and humeral shaft fractures.…”

An Anterosuperior Deltoid Splitting Approach for Plate Fixation of Proximal Humeral Fractures

“…Lin et al 25) carried out a plate fixation of displaced proximal humeral fractures in a total of 86 patients. In 43 patients, they carried out a standard delto-pectoral approach and in the other 43 patients, a deltoid-splitting approach.…”