Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

Huang, Qiang; Lu, Yao; Wang, Zhi Meng; Sun, Liang; Ma, Teng; Wang, Qian; Li, Ming; Liu, Hong Liang; Hou, Ming; Xue, Han Zhong; Zhang, Kun; Li, Zhong

doi:10.1186/s13018-021-02355-z

Cited by 6 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the limited area provided by the coronoid and anconal fossas, as well as the comparatively poor bone quality in the metaphyseal area, adequate bone holding with at least three screws can be difficult to accomplish in middle-inferior humerus fractures that stretch more distally and have a very short distal fragment [ 24 ]. The implant should be adjusted, or an alternative approach should be used to avoid these issues.…”

Section: Discussionmentioning

confidence: 99%

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The proximal incision was made at the median anterior humerus, the biceps brachii was pulled medially, and the lateral third of brachialis was split to expose the fracture position. The distal incision was made between brachioradialis and triceps 14 . In this paper, we included it in the anterolateral MIPO approach.…”

mentioning

confidence: 99%

Systematic review of humeral shaft fracture (OTA/AO 12) complicated with iatrogenic radial nerve injury: Can nerve fibers span a 3cm nerve defect?

Zhang,

Lin,

Qiu

et al. 2024

Preprint

View full text Add to dashboard Cite

Objectives: Compare and analyze the relationship between the implant (bone plate VS. intramedullary nail), surgical approach and iatrogenic radial nerve injury. Report a case which indicates the possible distance between two nerve stumps which radial never might crawl through. Methods: Reviewed the literatures on humeral fracture (OTA/AO 11/12/13 A/B/C9) combined with radial nerve injury was retrieved in PubMed. Screening scope includes: 1) Chinese or English literature, 2) adult humeral fracture, 3) preoperative radial nerve continuity, 4) non-pathological fracture, 5) non-periprosthetic fracture, 6) must involve humeral shaft (OTA/AO 12). Exclusion criteria: 1) No full text in Chinese or English; 2) Unable to judge surgical approach. Rejection criteria: 1) Misinclusion; 2) Unable to judge whether the humeral shaft was involved (OTA/AO 12). Results: 1. The rate of iatrogenic radial nerve injury with bone plate and intramedullary nail was 6.82% (313/4589) and 2.58% (23/893) respectively (p < 0.05). 2.In cases with open reduction and internal fixation with a plate with a definite surgical approach (excluding MIPO), the rate of radial nerve injury was 7.44% (259/3483). The corresponding rates were 3.7% (3/82) for deltopectoral approach, 5.65% (111/1963) for anterolateral approach, 13.54% (26/192) for lateral approach and 9.55% (119/1246) for posterior approach. There were statistical differences between anterolateral and lateral approaches and anterolateral and posterior approaches. 3.The injury rates of radial nerve were 7.26% (301/4145) for plate internal fixation, 2.58% (23/893) for intramedullary nail and 2.70% (12/444) for MIPO. There were statistical differences between plate fixation and intramedullary nail, plate fixation and MIPO (p < 0.05), but no difference between an intramedullary nail and MIPO (p > 0.05). 4. The radial nerve injury rates were 0.00% (0/33) for Anteromedial MIPO, 2.67% (10/374) for Anterolateral MIPO and 5.40% (2/37) for Posterior MIPO. (p > 0.05) 5. The radial nerve injury rates were 2.87% (21/732) for anterograde intramedullary nail and 1.2% (2/161) for retrograde intramedullary nail. (p > 0.05) 6. In nonunion surgery, the rate of iatrogenic radial nerve injury was 15.0% (9/60) for anterolateral approach, 16.7% (2/12) for lateral approach and 18.2% (6/33) for posterior approach. (p > 0.05) Conclusion: During humeral shaft fracture operation, the incidence of iatrogenic radial nerve injury was 6.82% in bone plate and 2.58% in intramedullary nails, respectively. Compared with lateral and posterior approaches, the anterolateral surgical approach had a lower incidence of radial nerve injury. The rate of iatrogenic radial nerve injury in MIPO was lower than that in open reduction and internal fixation. There was no difference in the incidence of iatrogenic radial nerve injury between anterograde and retrograde intramedullary nailing. In the human body, regenerated radial nerve fibers can span a 4cm nerve defect area. Level of Evidence: Level IV

show abstract

Humeral shaft fracture: systematic review of non-operative and operative treatment

Bergen

Mahabier

Lieshout

et al. 2023

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome. Methods Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc. Results A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84–92%), 94% (95% CI 92–95%) for the IMN group and 96% (95% CI 95–97%) for the plating group. The rate of secondary radial nerve palsies was 1% in patients treated non-operatively, 3% in the IMN, and 6% in the plating group. Intraoperative complications and implant failures occurred more frequently in the IMN group than in the plating group. The DASH score was the lowest (7/100; 95% CI 1–13) in the minimally invasive plate osteosynthesis group. The Constant–Murley and UCLA shoulder score were the highest [93/100 (95% CI 92–95) and 33/35 (95% CI 32–33), respectively] in the plating group. Conclusion This study suggests that even though all treatment modalities result in satisfactory outcomes, operative treatment is associated with the most favorable results. Disregarding secondary radial nerve palsy, specifically plate osteosynthesis seems to result in the highest fracture healing rates, least complications, and best functional outcomes compared with the other treatment modalities.

show abstract

Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

Cited by 6 publications

References 20 publications

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

Systematic review of humeral shaft fracture (OTA/AO 12) complicated with iatrogenic radial nerve injury: Can nerve fibers span a 3cm nerve defect?

Humeral shaft fracture: systematic review of non-operative and operative treatment

Contact Info

Product

Resources

About