Fracture of distal humerus: MIPO technique with visualization of the radial nerve

Abstract

OBJECTIVES: To evaluate the outcomes in patients treated for humerus distal third fractures with MIPO technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. METHODS: The patients were treated with MIPO technique. The visualization and isolation of the radial nerve was done by an approach between the brachialis and the brachiorradialis, with an oblique incision, in the lateral side of the arm. MEPS was used to evaluate the elbow function. RESULTS: Seven patients were evaluated with a mean age of 29.8 years old. The average follow up was 29.85 months. The radial neuropraxis after surgery occurred in three patients. The sensorial recovery occurred after 3.16 months on average and also of the motor function, after 5.33 months on average, in all patients. We achieved fracture consolidation in all patients (M=4.22 months). The averages for flexion-extension and prono-supination were 112.85° and 145°, respectively. The MEPS average score was 86.42. There was no case of infection. CONCLUSION: This approach allowed excluding a radial nerve interposition on site of the fracture and/or under the plate, showing a high level of consolidation of the fracture and a good evolution of the range of movement of the elbow. Level of Evidence IV, Case Series

Midterm Results of Minimally Invasive Plating Osteosynthesis Versus Open Reduction and Internal Fixation for the Treatment of Mid-distal Humeral Shaft Fractures: A Case-match Controlled Comparison Study

“…Intraoperative blood loss was 112.9 ± 75.3 (30-300) mL in the MIPO group and 229.5 ± 112.7 (100-600) mL in the ORIF group, with a highly signi cant decrease of 116.6 mL (t=5.63, p=0.000). The bone union time was 6.2±1.6 (4-9) months in the MIPO group and 6.0±3.3 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months in the ORIF group, with no statistical difference (t=0.06, p=0.951). Iatrogenic nerve injury was not observed in the MIPO group and 4 patients with iatrogenic radial nerve injury (7.1%) were postoperatively identi ed in the ORIF group with no statistical difference (X 2 =2.10, p=0.147).…”

“…7,8 Although the incidence of humeral shaft fractures is high, the incidence of the mid-distal shaft fractures is low, accounting for about 20% -30% of all humeral shaft fractures. 9 Zogbi et al reported 15 patients with this type of fracture in 6 years 10 . In the present study, two hospitals treated 84 patients with MIPO and ORIF in 5 years.…”

A New Minimally Invasive Approach for Treatment of Middle and Distal-third Humeral Shaft Fractures

“…The MIPO group required a shorter incision length, suffered less blood loss, and had a shorter postoperative hospitalization time and shorter fracture healing time, but on the other hand this technique involved an increase in the amount of radiation exposure during the operation, leading to a certain amount of radiation damage to physicians and patients 12 . Some studies have reported on a MIPO technique for middle and distal humeral shaft fracture by placing the plate using anterior approach for the proximal incision and lateral approach for the distal incision combined with exploration of the radial nerve through an oblique incision, however, an iatrogenic radial nerve palsy occurred in three of seven patients 13 .…”

Causes of Secondary Radial Nerve Palsy and Results of Treatment

“…To analyze the variable course of the distal radial nerve, we compared our results with the most prominent landmark bone points (the lateral and medial epicondyle) [ 25 , 26 ]. The results were comparable with anatomic studies of these points in which the distal extent of the radial nerve in the spiral groove was 12.6±1.1 cm proximal to the lateral epicondyle of the humerus [ 27 ], and along the posterior aspect of the humerus from 20.7±1.2 cm proximal to the medial epicondyle [ 28 ].…”