Background and purpose Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures. Methods The data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B). Results All the cases were followed up for 12–34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group. Conclusion MIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.
Background To explore the clinical efficacy of 3D printing assisted MIPO technique for treating complex middle-proximal humerus fractures(AO 12C fracture type). Methods The data of 42 participants who received a complicate middle-proximal humerus fracture from the beginning of 2018 to the end of 2021 were retrospectively analyzed. All patients were assigned to two groups: minimally invasive percutaneous plate osteosynthesis (MIPO) technique with detailed preoperative planning assisted by 3D printing (group A), and traditional MIPO (group B). Results All patients were followed-up for 8-24 months (mean: 16.12±4.13 months). There were obvious differences found in the operation time, c-arm usage time and intraoperative blood loss between the two groups. However, no significant differences were observed in the range of shoulder joint motion (ROM), the occurrence of complications (surgical incision site infection, flexible internal fixation, bone nonunion and radial nerve palsy), QuickDASH score and Constant score between the two groups. Conclusion Preoperative 3D printing assisted MIPO technique can reduce the operation time, and exhibits obvious advantages in terms of operational efficiency, which can be applied to treat complex middle-proximal humeral fractures.
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