Is minimally invasive plate osteosynthesis superior to open plating for fixation of two-part fracture of the proximal humerus?

Abstract

Purpose: Displaced two-part fractures of the proximal humerus are generally treated with open plate (OP) fixation. Recently, minimally invasive plate osteosynthesis (MIPO) has been increasingly favored for fracture healing and functional recovery. We aimed to compare OP and MIPO for two-part fractures of the proximal humerus to identify outcome differences. Methods: All patients who underwent OP or MIPO for a displaced two-part fracture of the proximal humerus at a single level I trauma center between 2007 and 2013 were retrospectively evaluated. Of the patients, 17 were treated using the OP method through the delto-pectoral approach and 19 with MIPO through deltoid splitting. Radiographic results were evaluated to determine the union rate, time to union, and alignment. Functional outcomes were measured with Constant and UCLA scores. Radiation exposure and operative time were also evaluated. Results: All patients achieved bone union without complication. In the OP and MIPO groups, no significant difference was observed in the neck shaft angles, constant scores, or UCLA scores. The OP group required less radiation exposure time than the MIPO group (p < 0.001). However, the OP group showed more operation time than the MIPO group (p < 0.001). Conclusions: Both techniques showed satisfactory radiographic and functional outcomes in two-part fractures of the proximal humerus. Although MIPO technique offers advantages, including minimal soft tissue damage and short operation time, surgeons and patients should be warned of the invisible risk from the radiation hazard.

Comparison between minimally invasive plate osteosynthesis and open reduction–internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals

“…Kim et al. [28] reported that the MIPO technique via the deltoid-splitting approach can provide sufficient field of vision of the plate location by minimal soft tissue dissection. Thus, it is easy to perform a reduction of a large greater tuberosity fragment [22], significantly reducing operation time and blood loss.…”

“…were included in the meta-analysis [9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The flow diagram of the included studies is shown in Figure 1.…”

“…The methodological quality of the RCTs [9,27] was assessed by the Cochrane Handbook, the assessment results are summarized in Figure 2. The quality index scores of the non-RCTs [10,[15][16][17][18][19][20][21][22][23][24][25][26]28] were 14-20. The assessment results are summarized in Table 2.…”

“…Three articles [23,26,28], with 189 patients, stated radiation time, but used different units of time;…”

“…The constant score of Neer type II fractures were provided in four studies [9,15,23,27,28]. A fixedeffects model was used (P = 0.16; I 2 = 39%), and analysis showed significantly higher score in the MIPO group than in the ORIF group (MD = 2.24; 95% CI: 0.82 to 3.65; P = 0.02; Figure 8).…”