Minimally Invasive Plate Osteosynthesis Using a Helical Plate for Metadiaphyseal Complex Fractures of the Proximal Humerus

Abstract

Minimally invasive plate osteosynthesis (MIPO) has been used for humeral shaft fractures, but concerns exist about soft tissue injuries. The purpose of this study was to report the surgical technique and clinical outcomes of MIPO using a helical plate for metadiaphyseal complex humeral shaft fractures. Twelve patients with acute displacement involving proximal and middle third humeral shaft fractures (AO type C) were treated using the MIPO technique with a helical plate. Fracture union, complications, and functional outcomes were evaluated using the Constant-Murley score and Mayo Elbow Performance Score (MEPS) at final follow-up. All fractures united at an average of 17.9 weeks. No major complications, such as neurovascular injury, infection, and nonunion, were observed. Mean Constant-Murley and MEPS scores at final follow-up were 88.6 and 97.9, respectively. A MIPO technique using a helical plate can be a useful surgical option for metadiaphyseal complex fractures of the humeral shaft.

Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients

“…For the use of the MIPO technique on humerus fractures with proximal extension, there has been debate in the literature on subjects, such as the incision site, the plate length, plate location, radial and axillary nerve protection, and whether or not the plate should be contoured. 13 , 14 , 18 , 21 , 22 While some authors have used a deltoid split in the proximal and lateral approach in the distal, others have preferred plating with a deltopectoral approach. With regard to the choice of plate, PHILOS plate, helical plate, and humerus proximal plates with specific distal contouring can be used.…”

“…Moon et al used helical plates in their studies and Brunner et al used the PHILOS plate with an anterior distal curve. 18 , 22 The authors reported that in this way, safe plating could be applied distant from the radial nerve as the distal of the plate comes onto the anterior surface of the humerus. 18 …”

“…In deltopectoral plating, the nerve is not at risk. 21 , 22 In the deltoid-split approach, plating can be applied protecting the nerve without exploration. 13 , 18 In the current study, routine exploration of the axillary nerve was not considered necessary.…”

“… 20 Removal of the implant may be required in treatment. 22 Brunner et al reported that it was necessary to remove the implant in 3 patients of a series of 15. 18 In the current series, subacromial impingement syndrome developed in 2 patients.…”

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures

“…In the past, internal fixation or intramedullary nailing fixation with conventional screws and plates was primarily performed for the treatment of humeral shaft fracture, but, in recent years, the use of MIPO technique is increasing. 11 12 13 14) The MIPO technique is generally used for shaft fractures and metaphyseal fractures accompanying osteoporosis, which can be treated with indirect reduction as anatomical reduction is not required and for multi-fragmentary fractures, which can be treated with bridging plate fixation. However, the MIPO technique can also be used for simple shaft fractures and metaphyseal fractures.…”