Modified medial minimally invasive plate osteosynthesis techniques for the treatment of distal third diaphyseal fracture of humerus using a double plate technique

Abstract

Purpose The surgical approach and the placement of plates for the treatment of distal third diaphyseal fracture of the humerus are controversial. The aim of this retrospective study was to evaluate the clinical and radiographic outcomes when modified medial minimally invasive plate osteosynthesis (MIPO) techniques for the treatment of distal third diaphyseal fracture of the humerus using a double plate technique were performed.Methods A total of 20 patients with a distal third diaphyseal fracture of the humerus were selectd from our hospital. Patients were seen between January 2017 and May 2019. They were treated with a modified medial approach combined with MIPO techniques using a double plate technique. Patient demographics, operation time, bleeding volume, union time, complication, the mean fracture length(FL) and distal cortical length (DCL), and the number of screws in the distal fragment were analyzed. The function of the shoulder and elbow were evaluated using Neer's assessment of the shoulder and Mayo's assessment of the elbow.Results The FL was 57.7 ± 7.7mm and the DCL 39.1 ± 5.2mm. The mean operative time was 88.3 ± 12.6min (range 60-110min). The mean blood loss on surgical treatment was 47.8 ± 10.6ml(range 30-60ml). Bone healing was observed in all patients from 10 to 14 weeks (average 11.9 ± 1.8) and there were no complications recorded. All the patients had good function of both the shoulder and elbow. The maximum flexibility of the elbow ranged from 130° to 145° (average 138.5 ± 4.9°) with maximum flexibility straightness 0° to 5° (average 2.2 ± 1.5°). The Mayo elbow joint function score was 80–100 (average 92.7 ± 5.1). The Neer shoulder joint function score was from 85–100 (average 93.6 ± 3.5).Conclusion The modified medial approach had the advantages of no iatrogenic radial nerve nor ulnar nerve injuries. The anterior and the medial side plate were fixed perpendicular to the distal humerus and can offer higher stability at the same time producing better shoulder and elbow joint function.