Open vs. closed reduction combined with minimally invasive plate osteosynthesis in humeral fractures

Abstract

Aim To explore a more effective surgical procedure, the outcomes of closed manipulative reduction (CMR) combined with minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and internal fixation (ORIF) for treating proximal humeral fractures were compared. Material and methods In a retrospective study of patients operated for humerus shaft fractures from April 2008 to July 2011, the outcomes of 33 patients treated with CMR/MIPO were compared with the outcomes of 42 patients treated with ORIF. The fractures were classified, and the incision length, blood transfusion, operating time, as well as the VAS (Visual Analog Scale) pain scores were analyzed. The neck-shaft angles of the proximal humerus were detected, and the postoperative function of the shoulder was evaluated. Results The mean values of incision length, blood transfusion, and VAS pain scores at the 1st and 3rd day after CMR/MIPO and operation time were lower than that of ORIF. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. Meanwhile, in the ORIF group, nonunion (three cases) and humeral head necrosis (four cases) were detected. Conclusions The MR/MIPO technique showed smaller incisions, easier operation, less blood transfusion and more effective recovery of shoulder joint function for treating proximal humeral fractures than ORIF.

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials

“…The MIPO technique using the relative stability principle in shaft fractures has gained popularity for its potential advantage in causing fewer soft-tissue complications. [8, 9, 39, 40] Open reduction and internal fixation through either an anterolateral or posterior approach needs significant soft-tissue and local vascularity disruption, which may lead to a decreased fracture healing potential and increase the incidence of iatrogenic radial nerve injury and deep infection. [33] This meta-analysis showed that the MIPO technique had a significantly lower incidence rate of iatrogenic radial nerve injury than ORPF.…”

Comparison between minimally invasive plate osteosynthesis and open reduction–internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals

“…By reading the title and abstract, 355 papers were excluded according to the inclusion and exclusion criteria. A total of 42 studies were assessed by reading the full text; eventually, 16 studies involving 1050 patients (464 patients in the MIPO group and 586 patients in the ORIF group) were included in the meta-analysis [9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The flow diagram of the included studies is shown in Figure 1.…”

Comparison between minimally invasive plate osteosynthesis and open reduction–internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals

“…were included in the meta-analysis [9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The flow diagram of the included studies is shown in Figure 1.…”

“…The methodological quality of the RCTs [9,27] was assessed by the Cochrane Handbook, the assessment results are summarized in Figure 2. The quality index scores of the non-RCTs [10,[15][16][17][18][19][20][21][22][23][24][25][26]28] were 14-20. The assessment results are summarized in Table 2.…”