Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds of humeral shaft fractures

Abstract

Purpose Options for the treatment of proximal-and middle-thirds of humeral shaft fractures include intramedullary interlocking nail (IMN) and minimally invasive plate osteosynthesis (MIPO). However, whether IMN provides better clinical outcomes than MIPO surgical technique still remains unclear. This study was designed to compare clinical outcomes of the IMN with MIPO technique for the treatment of proximal-and middle-thirds of humeral shaft fractures. Method A retrospective cohort analysis of 55 proximal-and middle-thirds of humeral shaft fractures surgically treated using IMN (n = 25) or MIPO (n = 30) from January 2012 to January 2016. Peri-operative and follow-up data (a minimum of 1 year) of the patients (aged from 18 to 56 years) were collected. Operative time, union time, VAS scores, surgery-related complications, and implant removal rate were compared between the two groups in this study. Besides, the functional outcomes were evaluated using the Rating Scale of American Shoulder and Elbow Surgeons' Form (ASES) and Mayo Elbow Performance Score System (MEPS). Result We found significantly shorter operative time and much less blood loss in IMN group, and lower VAS scores in the IMN group after surgery at first and third months but not at the sixth month. Complication rate was found to be relatively higher in the MIPO group when compared to the IMN group. No significant difference was observed between these two groups regarding ASES and MEPS scores. Three patients in the MIPO group suffered iatrogenic radial nerve injury and recovered after four to five months later. No implant failures occurred in either group. Conclusion Intramedullary interlocking nail seemed to be superior to minimally invasive plate osteosynthesis in the treatment of proximal-and middle-thirds of humeral shaft fractures due to shorter operative time and union time, less early post-operative pain, and fewer complications. The intramedullary interlocking nail could be considered a better surgical option for the management of proximal middle humeral fractures, though it may also depend on the surgeons' skills and learning curve. Further indepth prospective studies are in great need to verify our conclusion.

Assessment of Shoulder Function after Internal Fixation of Humeral Diaphyseal Fractures in Young Adults: A Prospective Comparative Study

“…ese conclusions are different from the study of Wang et al [16] who reported more nonunion and radial nerve lesions in the MIPO group.…”

“…MIPO technique was developed to avoid soft tissue and periosteal violations associated with ORIF, so it has lower rate of postoperative infections and fracture nonunion and better cosmesis. However, most published studies have reported more operative time and blood loss for MIPO compared with IMN [16].…”

“…is can be attributed to the time taken for fracture manipulation to achieve good reduction and proper alignment. Also, in a retrospective study, Wang et al [16] showed that the nail group had shorter duration of operation with less exposure to radiation.…”

“…No malunion was found in the nail group. Also, Wang et al [16] reported 2 cases of malunion in 30 patients treated by MIPO.…”

Ultrasound-guided Preoperative Localization of Radial Nerve in the Treatment of Extra-articular Distal Humeral Shaft Fractures

“…2), and fracture reduction clamps were used to reduce the fracture fragments. An extra-articular distal humeral plate was applied centrally over the posterior surface of humeral shaft and locking screws were placed on the either side of the humeral fracture to stabilize the reduction [4].…”