Anterior minimally invasive bridge-plate technique for treatment of humeral shaft nonunion

Abstract

BackgroundThe present study introduces a new surgical technique and the results of a case series of patients with humeral shaft nonunion.Materials and methodsFifteen patients with diagnosis of diaphyseal nonunion of humerus were operated by a bridge-plate technique. A 4.5-mm plate is slid on the anterior surface of the humerus, submuscular to the brachial muscle. With the plate over the anterior surface of the humerus, screws are inserted from anterior to posterior on the ends of the plate. When there is a small bone gap, an iliac autologous graft is inserted. Minimum follow-up was 1 year.ResultsBone healing was obtained in all patients: 1.5 months postoperatively in 11 patients, 2 months in 3 patients, and 3 months in 1 patient. There were no postoperative infections, there was one case with loosening of the screws and plate, and there were no nerve injuries.ConclusionsThe present technique avoids wide dissection, radial nerve isolation, and periosteum stripping. The anterior minimally invasive bridge-plate technique for treatment of humeral shaft nonunion is a safe procedure and obtained bone healing in all patients in this series.

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

“…The ABP follows the principle of relative and elastic stability instead of the absolute rigidity in the open reduction and internal fixation (ORIF) achieved by a posterior approach. In the former, healing takes place by secondary healing and callus formation, which is stronger, whereas in the latter, it is done by primary healing without callus formation 4614). The purpose of using a long plate in ABP is to decrease the stress per unit area as by distributing over a larger surface area 24).…”

“…The recent literature search gives numerous publications pertaining to this topic in a variety of case scenarios 46789). However, to the best of our knowledge, there are no studies exclusively dealing with mid-shaft humerus fractures in patients predominantly involved in overhead activities: i.e., athletes and manual laborers who perform activities that place extra load on the upper limbs.…”

New Minimally Invasive Bridge-Plate Technique for Treatment of Atrophic Humeral Shaft Nonunion

“…Moreover, there is lack of reports in the literature on use of this technique for nonunions (2,3). Being a minimally invasive technique, complications are reduced (5,7,8).…”

“…With the plate slid over the anterior surface of the humerus and respecting the approaches previously described, the radial nerve is totally protected (2)(3)(4)6) and there is no inherent danger to any vascular structure.…”

“…He was treated non-operatively with Sarmiento brace. At this visit, he was operated in supine position following previously described technique (2)(3)(4), with the bone graft removed from the contralateral iliac crest in case of atrophic nonunion. In distal humerus region, a four-cm anterior longitudinal incision was made on the lateral border of the biceps.…”