Surgical approach for fracture of distal humerus: Posterior <em>vs</em> lateral

Abstract

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

Which Surgical Treatment Is Preferable in Humeral Diaphyseal Fractures? A Systematic Review

“…17 Moreover, not infrequently, the fracture can involve the distal third of the humerus requiring adjunctive open reduction and plating. 15 On the contrary, ORIF allows an anatomical reduction of the fracture but involves the exposure of the fracture site, the excision of part of the periosteum and the risk of iatrogenic damage of the radial nerve. Moreover, it is more bleeding and it has a hypothetical higher risk of infection.…”

“…[7][8][9][10][11]13 Two are the data relating to the MIPO technique (mean: 113.36 minutes; min: 95; max: 131.71). 15,16 WHICH SURGICAL TREATMENT IS PREFERABLE IN HUMERAL DIAPHYSEAL FRACTURES? A SYSTEMATIC REVIEW The average value related to nailing is 89.63 minutes (min: 50.8; max: 126), while the average time related to ORIF is 109.32 minutes (min: 64.2; max: 150.58).…”

Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

“…It still needs open reduction and internal fixation through the proximal and distal incisions. An incision, which allows a good fracture’s visualization, is always fundamental in order to ensure acceptable reduction and to allow the exploration of the radial nerve, not rarely involved in the trauma, as well as to protect it from possible iatrogenic damage [ 9 ]. Similar to MIPO technique, attention should be paid to the protection of blood supplies at the fracture site and the reduction of periosteum peeling.…”

“…In the posterior median approach, surgeons split triceps brachii and enter between the lateral head and long head to expose fracture [ 8 ]. Drawbacks to the posterior approach are lateral or prone patient positioning which may be problematic for polytraumatized patient or in case of thoracic trauma; radial nerve mobilization for plate application, theoretically increasing the risk of iatrogenic palsy [ 9 ]. Some scholars have proposed modified approaches, which lead to different reduction and fixation effects.…”

Surgical Treatment Effect of Distal Humeral Shaft Fractures: A Prospective Cohort Study on Comparison of Lateral and Posterior Plating techniques

“…Among the plating techniques used for this purpose, two are extensively employed: lateral plating and posterior plating approaches. Both position and corresponding surgical approach have been applied successfully [14,15]. However, only few comparative studies about these two surgical techniques have been reported.…”