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

Abstract

BackgroundTo assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers).MethodsForty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered.ResultsMost patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation.ConclusionsABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.

Prospective study of clinical, radiological and functional outcome of anterior bridge plating for shaft of humerus fracture

“…In the present study, we found varus/valgus angulation in 13.3% patients and one case each of radial nerve neuropraxia, delayed union, and screw back out/loosening. These complications were similar to those in the studies by Sharma et al and Mahajan et al 18,26 The current study was limited by the lack of a comparison group and by the short duration of follow-up.…”

“…Most of the fractures (60%) in our study were united in 9-12 weeks. Similar observations were noted in the studies of Sharma et al, Vegad et al, Ibrahim et al, and Mahajan et al 18,20,21,26 At 18,26 Although the difference in the range of motion between the operated and non-operated sides was statistically significant, there was no clinical difference in subjective postoperative strength.…”

“…This is because in the former, healing takes place by secondary healing and callus formation, which is stronger, whereas the latter involves primary healing without callus formation. 17,24,26 Furthermore, the purpose of using a long plate in anterior bridge plating is to decrease the stress per unit area by distributing it over a larger surface area. 25 Therefore, the plate placed on the anterior tensile surface can withstand a larger amount of rotational and bending stresses than the shorter plate.…”

Shoulder and Elbow Fractures in Athletes

“…However, the morbidity of soft tissue dissection may significantly delay an athlete's return to sport and affect their ability to pitch at the same level. To avoid an extensive dissection, minimally invasive percutaneous plate osteosynthesis (MIPPO) was developed and considered for patients predominantly involved in overhead activities [22]. Mahajan et al [22] evaluated MIPPO for diaphysis humeral fractures in 48 patients who were predominantly involved in overhead activities, including athletes and manual laborers.…”

“…To avoid an extensive dissection, minimally invasive percutaneous plate osteosynthesis (MIPPO) was developed and considered for patients predominantly involved in overhead activities [22]. Mahajan et al [22] evaluated MIPPO for diaphysis humeral fractures in 48 patients who were predominantly involved in overhead activities, including athletes and manual laborers. Excellent clinical and functional results were reported, with no significant differences in function compared to the unaffected arm.…”