Treatment of Diaphyseal Humeral Fractures With the Minimally Invasive Percutaneous Plate (MIPPO) Technique: A Cadaveric Study and Clinical Results

López-Arévalo, Rafael; Llano-Temboury, Alfonso Queipo de; Serrano-Montilla, J.; Llano-Giménez, Enrique Queipo de; Fernández-Medina, J.M.

doi:10.1097/bot.0b013e3181f98421

Cited by 17 publications

(11 citation statements)

References 26 publications

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“…Currently, open reduction and plate fixation remains to be the golden standard for humeral shaft fractures [ 9 , 10 ]. Recently, minimally invasive plate osteosynthesis (MIPO) techniques with encouraging results in humeral shaft fracture patients have been reported [ 11 – 14 ]. This technique has advantages of less soft tissue dissection, a high rate of union, low risks of infection, and no need for radial nerve exposure [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

et al. 2016

J Orthop Surg Res

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BackgroundIn this study, we performed a meta-analysis to identify whether minimally invasive plate osteosynthesis (MIPO) was superior to conventional fixation techniques (CFT) for treating humeral shaft fractures.MethodsA systematic literature search was conducted up to February 2016 in ScienceDirect, Springer, MEDLINE, and PubMed databases for relevant papers that compared the outcomes of MIPO with CFT, such as open reduction with plate osteosynthesis (ORPO) and intramedullary nail (IMN) for treating humeral shaft fractures. Meta-analysis was performed with Review Manager 5.0 software.ResultsAccording to the search strategy, eight studies that covered 391 patients were enrolled, including four randomized controlled trials (RCTs), two prospective cohort trials, and two retrospective cohort trials. Our meta-analysis did not detect any significant difference between MIPO and CFT (IMN and ORPO) in terms of operative time, fracture union rate, and fracture union time. However, MIPO has a less rate of complications and iatrogenic radial nerve palsy than that of ORPO and higher adjacent joint function scores than those of IMN (p < 0.05).ConclusionsBased on the present evidence, this meta-analysis suggested that MIPO was a better choice for treating humeral shaft fractures than CFT. However, more high-quality randomized trials are still needed to further confirm this conclusion in the future.

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Section: Introductionmentioning

confidence: 99%

Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

et al. 2016

J Orthop Surg Res

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“…Fracture union was achieved in all the patients by the end of 20 weeks (mean of 14.83 weeks) Figure (2,3,4). UCLA shoulder assessment score at 6 months post-operative follow-up classified 2 patients (8.69%) as excellent (34-35), 15 patients (65.21%) as good (28-33), 6 patients (26%) as fair (22)(23)(24)(25)(26)(27). It was observed that the majority of the cases had excellent and good UCLA scores as shown in Tables 1 and 2.…”

Section: Resultsmentioning

confidence: 99%

“…Some surgeons still consider radial nerve palsy an indication for surgical exploration and ORIF, the current consensus for the closed fracture is an expectant policy of observation and monitoring nerve injuries unless they were the direct result of an attempted maneuver. 26 It could be said that MIPO is preferred due to the advantage of having a limited skin incision thereby offering a better cosmetic appearance along with less risk of infection and iatrogenic radial nerve injury. In addition, radiation exposure to the patient and surgeon is less with excellent shoulder and elbow function, leading to patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Functional and Radiological Outcome in the Management of Diaphyseal Humeral Shaft Fracture Using the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) Technique

et al. 2022

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Introduction: Minimally invasive percutaneous plate osteosynthesis (MIPO) is gaining preference nowadays compared to other treatment modalities for diaphyseal fracture of the humerus. We have evaluated the functional and radiological outcome of diaphyseal humeral shaft fracture with the MIPO technique. Methods: A hospital-based prospective study was conducted on 23 adult patients with diaphyseal fracture of the humerus and treated with the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) technique. In all cases, 4.5mm locking compression plates were applied. Clinical and radiological evaluation was done at 6 weeks, 3 months, and 6 months. Results: Out of 23 patients, the mean age of patients was 40.3 years. The maximum number of cases were caused due to road traffic accidents 14 (60.9%). The left side was commonly affected with a maximum number of them being Type A fracture 13 (56%) as per AO/OTA classification. The mean operative time was 106 minutes and fracture union was achieved in all patients by the end of 20 weeks (mean 14.83 weeks). In the study group, 1 patient had superficial infection with no evidence of iatrogenic radial nerve injury or implant failure. Shoulder and elbow ROM was restored to normal range. Conclusion: MIPO is a safe and effective technique for the management of diaphyseal humerus fractures, with early fracture healing, less risk of complications such as superficial or deep infection, implant failure, and iatrogenic radial nerve injury, along with a cosmetically acceptable scar.

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“…Although there are case studies in which iatrogenic radial nerve damage was never seen in patients who underwent bridge plating with the MIPO technique, 3.4-4% radial nerve palsy and 3.4% nonunion complications were reported (6,10,14). On the other hand, the non-union rates with MIPO technique were reported to be lower than the functional brace (10,14).…”

Section: Discussionmentioning

confidence: 99%

“…Although it was technically possible to find and protect the radial nerve, safe zones have been the most important subject of research due to the current risk. For this reason, many cadaveric studies have concluded that the anterior submuscular zone is safe (14,15). In the light of the available evidence, the idea of twisting and bending long PHILOS plates to conform to the humeral anatomy and to use them for fixation in metaphysiodiaphyseal fractures was first reported by Brunner et al (16), in 2012.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

AYDOGAN>

AKAR>²,

Pehlivanoğlu³

et al. 2022

Journal of Health Sciences and Medicine

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Aim: In order to achieve adequate stability in segmental humerus fractures, the PHILOS fixation with minimal invasive approach comes into use instead of conventional plating. However, according to the AO classification, 12C type segmental humerus fractures treated with minimally an invasive method are prone to complications. The purpose of this prospective study is to compare functional outcomes and complication rates following two different angled helical PHILOS plate fixation. Material and Method: This multicenter study is a prospective review of cases with a final follow-up outcome. Twenty-two patients with AO 12-C humerus fractures underwent PHILOS fixation with contoured PHILOS plates between January 2016 and June 2019. Patients evaluated in two groups. Group 1 consisted 12 patients who were treated with a 30° helical plate and Group 2 consisted 10 patients who were treated with 70° helical plate. Clinical outcomes were noted according to the Constant-Murley scoring system. Results: The mean age of patients treated in groups 1 and 2 were 49±15.8 and 50.7±17, respectively. Fractures healed in an average of 13.1±3.9 weeks in Group 1 and 13.8±3.1week in Group 2, respectively. The mean follow-up period of the patients was 18±6.1months in Group 1 and 22±4.2 months in Group 2. Mean Constant-Murley scores at final follow-up were 88±2.7 and 90±2.5 in Groups 1 and 2 respectively (p=.665). Radial nerve neuropraxia was seen in 2 cases in Group 1, and a sensorial injury of the musculocutaneous nerve was seen in 1 patient in Group 2 (p=.365). Conclusion: Similar union rates and successful clinical results were obtained from both groups. However, this study suggests that the 70° angled helical PHILOS technique could be performed relatively easily in AO 12-C fractures with fewer complication rates. Musculocutaneous nerve affliction can be as functionally destructive as radial nerve affliction.

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Treatment of Diaphyseal Humeral Fractures With the Minimally Invasive Percutaneous Plate (MIPPO) Technique: A Cadaveric Study and Clinical Results

Abstract: The results obtained with this technique are encouraging. The technique was associated with no shoulder pain and an almost complete restitution of strength and articular range of motion. Within 6 months, 96% of the patients returned to their normal activities.

Cited by 17 publications

References 26 publications

Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

Functional and Radiological Outcome in the Management of Diaphyseal Humeral Shaft Fracture Using the Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO) Technique

Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

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