Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Abstract

RESEARCH • RECHERCHE Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series studyBackground: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. Methods:We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.Results: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. Conclusion:The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves. Contexte :Il existe peu d'approches chirurgicales pour corriger la fracture de la diaphyse humérale. Nous présentons ici les résultats que nous avons obtenus avec une approche sous-brachiale.Méthodes : Nous avons réalisé une série de cas rétrospective regroupant des patients ayant subi une chirurgie pour réparation de fracture de la diaphyse humérale entre janvier 1994 et janvier 2008. Nous avons divisé les patients en 4 groupes selon l'approche chirurgicale employée (antérieure, antérolatérale, postérieure et sousbrachiale). Nous avons utilisé une plaque de compression dynamique AO de 4,5 mm.Résultats : Pendant la période de l'étude, 280 patients de 30 à 36 ans ont subi une chirurgie pour fracture de la diaphyse humérale. La durée moyenne de la chirurgie a été la plus courte avec l'approche sous-brachiale (40 min). La perte moyenne de force musculaire a été de 40 %, 48 %, 42 % et 20 % avec les approches antérolatérale, postérieure, antérieure et sous-brachiale, respectivement. La perte moyenne de tension dans le muscle brachial après 4 mois était respectivement de 61 %, 48 %, et 11 % avec les approches antérolatérale, antérieure et sous-brachiale. Seize patients des groupes soumis aux approches antérolatérale et antérieure et 6 patients du groupe soumis à l'approche postérieure ont subi des lésions peropératoires du nerf radial. Aucune complication postopératoire n'a été observée dans...

Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

“…The overall healing rate was 98.2%, without a significant difference in the approach or plate location. In accordance with the findings reported by Boschi et al [15], no significant difference in the operative duration was found between the two groups in our study; however, we found a wide variation in the operative duration within the groups. As a level one trauma center and a university hospital, all operative procedures in both groups were performed by either trainee registrars or junior consultants, which might be one reason for the wide variation in the operative duration within the groups.…”

“…Two patients (2.1%) were noted to have secondary palsy (hypoesthesia in the lateral antebrachial cutaneous nerve distribution) after surgery. Another retrospective study was published by Boschi et al [15] investigating the outcomes of the treatment of 280 humeral shaft fractures with ORIF in terms of the approach and plate location. The overall healing rate was 98.2%, without a significant difference in the approach or plate location.…”

Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study

“…The delayed union rates (7% in groups I and III vs. 4% in groups II and IV) and the non-union rates (0% in groups I and III vs. 2% in groups II and IV) in the current study are consistent with the results reported by Boschi et al [31] and Lotzien et al [32]. In a multi-center study, Femke et al [33] retrospectively analyzed 325 patients with humeral shaft fractures who underwent surgical treatments and reported iatrogenic radial nerve dysfunction in approximately 11% of patients treated with posterior exposure.…”

Anteromedial Plating of Humerus—An Easier and Effective Approach

“…Oh [7] in his study compared open reduction with internal fixation and minimally invasive plate osteosynthesis in humeral shaft fractures he reported no difference in fracture union however radiation hazard was high with mippo technique. Boschi [4] in his study concluded subbrachial approach as practical and effective and the loss of muscle strength was significantly less with subbrachial approach. In our study medial plating was done through anterolateral approach without splitting the brachialis, the brachialis was elevated and retracted laterally…”

“…In most instances dynamic compression plating is preferred [2] [6] [8]. The most commonly used approach are the posterior and anterolateral approaches [4] [7]. Oh [7] in his study compared open reduction with internal fixation and minimally invasive plate osteosynthesis in humeral shaft fractures he reported no difference in fracture union however radiation hazard was high with mippo technique.…”