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

Abstract

BackgroundThis study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures.MethodsThis retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated.ResultsThe average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks).ConclusionsMIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.

Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients

“…17 studies [ 8 , 14 , 17 , 19 , 24 , 26 , 27 , 30 – 32 , 34 , 36 , 39 , 43 , 44 , 46 , 48 ] reported on the effect of minimally invasive plate osteosynthesis, consisting of 436 patients. In 12 patients (3%), treatment was complicated by secondary RNP.…”

“…In 14 out of 467 patients (3%) in whom an anterolateral approach was used [ 17 – 19 , 22 , 24 , 26 , 27 , 30 – 32 , 34 , 36 , 39 , 43 , 44 , 46 , 48 ] and in 17 out of 356 (5%) patients in whom a posterior approach was used [ 8 , 14 , 23 , 25 , 40 , 41 ], treatment was complicated by secondary RNP (Table 6 ). In none of the 46 patients in whom a lateral approach was used secondary RNP occurred [ 16 , 25 ].…”

“…21 studies [ 8 , 10 – 15 , 17 , 19 , 21 – 23 , 25 , 27 , 33 , 35 , 36 , 40 , 42 , 44 , 48 ], with a weighted mean follow-up of 19 months, described the recovery from secondary RNP. 51 out of 54 patients with secondary RNPs recovered without reintervention (94%) (Table 5 ).…”

Outcome of Minimally Invasive Plate Osteosynthesis for Comminuted Diaphyseal Humeral Fractures

“…MIPO is a new procedure for treating humeral shaft fractures that require close attention to the periosteum, muscles, and nerves. This technique is commonly used for shaft fractures and metaphyseal fractures associated with osteoporosis that can be treated with indirect reduction as anatomical reduction is not required, as well as comminuted fractures that can be treated with bridging plate fixation and achieve good results [12,14]. This technique has the advantage of requiring less soft tissue dissection and avoiding the need to expose the radial nerve, resulting in a lower risk of iatrogenic radial nerve palsies and deep infection [15].…”

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

“…Although open dynamic compression plating (ORIF) provides more accurate anatomical reduction and rigid fixation and reduces the risks of malunions, it requires wide intraoperative exposure with more soft tissue injury. is may contribute to high infection rates and increased rates of nonunion due to violation of soft tissue at the fracture site and severance of periosteal blood supply [7].…”