Surgical treatment of extra-articular distal-third diaphyseal fractures of the humerus using a modified posterior approach and an extra-articular plate

Páramo-Díaz, P.; Arroyo-Hernández, Marta; Vega, Victor Rodriguez; Aroca-Peinado, M.; Leon-Baltasar, Jose Luis; Caba-Doussoux, Pedro

doi:10.1016/j.recote.2017.10.002

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…However, surgical treatment using EADHP is likely to be associated with skin prominence (Figure 1) by the plate itself and subsequent discomfort in activities of daily living, which can cause discomforts and require implant removal. 15,17 Furthermore, in many cases, the plate is inevitably placed beneath the radial nerve. Therefore, despite meticulous adhesion release, the nerve is constantly at risk of iatrogenic injury during implant removal.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Lim

Yoon

Choi

et al. 2020

Journal Orthopaedic Research

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The extra-articular distal humerus locking plate (EADHP) is widely used for distal extra-articular diaphyseal humeral fracture fixation. However, it occasionally causes skin prominence and discomfort. The upside-down use of a proximal humerus internal locking system (PHILOS) plate is suggested as an alternative option, but it lacks biomechanical evidence. The purpose of this study was to compare the biomechanical performance between two different fixation methods: the modified use of the PHILOS plate on the anterior cortex versus conventional use of an EADHP on the posterior cortex. Twelve pairs of fresh-frozen cadaveric humeri were used and 7 mm gap osteotomy was performed at 50 mm proximal to the lateral epicondyle to simulate an AO/OTA 12-C1.3 fracture type. Single load to failure was measured after five stiffness tests of the plate-bone constructs in anterior/posterior bending, internal/external torsion, and axial compression. There were no significant differences in metrics between the two groups, except for the load to failure in posterior bending, which was significantly higher for PHILOS (1589.3 ± 234.5) compared to EADHP (1430.1 ± 188.6), p < .023. In conclusion, the modified use of the PHILOS plate showed comparable biomechanical performance compared to the conventional EADHP. The new fixation method offers potential clinical advantages, considering the patient's position and surgical approach at the time of surgery as well as postoperative soft tissue irritation. Therefore, this could be an option for distal humeral extra-articular diaphyseal fracture fixation when the use of EADHP is not suitable or preferred.

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Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Lim

Yoon

Choi

et al. 2020

Journal Orthopaedic Research

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“…In relation to infection, in our series we did not have cases of superficial or deep infection, similar to results reported in other publications concerning the MIPO technique. 4 , 9 Páramo-Díaz et al 14 reported an 8.7% of superficial infection for the open approach.…”

Section: Discussionmentioning

confidence: 98%

“…In fractures involving the junction of the middle and distal thirds of the humerus, single column osteosynthesis with an extra-articular distal humerus plate (EADHP) using the triceps sparing posterolateral approach has gained popularity among surgeons with studies reporting excellent functional results and low complication rates. 1 , 11 , 14 , 18 This plate has a shape that is adapted to the posterior surface of the humerus, which in most cases presents an adequate fit and biomechanical characteristics that render it a reliable and safe alternative in fractures of the distal humeral shaft. 13 , 15 …”

mentioning

confidence: 99%

Treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve: minimum one-year follow-up

Contreras,

Soto,

Valencia

et al. 2024

JSES Reviews, Reports, and Techniques

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“…All the patients signed informed consent and agreed to join this trail. They were then randomized into two groups before surgery double blindly using draw lots, patients with odd number (1,3,5,7,9) were included into Group A (intramedullary nail combined with anterior minimally invasive plate group) and even numbers (2, 4, 6, 8, 0) were included into Group B (posterior approach double plate group). In group A, there were 40 patients including 22 males and 18 females, the average age was 40.5 AE 9.9 years, fracture classification: 12 cases of type A, 25 cases of type B and 3 cases of type C. There were 43 cases in group B, including 24 males and 19 females; The average age was 38.9 AE 13.3 years.…”

Section: General Informationmentioning

confidence: 99%

Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis

Fu,

Zhang,

et al. 2023

Orthopaedic Surgery

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ObjectiveThe treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures.MethodsThe data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant–Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t‐tests was used for follow‐up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant–Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow.ResultsThere was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant–Murley shoulder function score at the last follow‐up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01).ConclusionA humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.

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Surgical treatment of extra-articular distal-third diaphyseal fractures of the humerus using a modified posterior approach and an extra-articular plate

Cited by 4 publications

References 14 publications

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Biomechanical evaluation of a modified proximal humeral locking plate application for distal extra‐articular diaphyseal humeral fractures

Treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve: minimum one-year follow-up

Treatment of Distal Third Humeral Shaft Fracture with Intramedullary Nail Combined with Anterior Minimally Invasive Plate Osteosynthesis

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