Open reduction and internal fixation of humeral midshaft fractures: anterior versus posterior plate fixation

Abstract

BackgroundFractures of the humeral shaft represent 2–4% of all fractures. Fractures of the humerus have traditionally been approached posteriorly for open reduction and internal fixation. Reports of treating midshaft fractures with an open anterolateral approach and anterior plating are limited. The purpose of this study was to evaluate a series of humeral shaft fractures treated with plate osteosynthesis regarding the effect of the approach and plate location on the healing rate and occurrence of complications.MethodsWe conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated with anterior or posterior plate fixation. Selection of the approach to the humerus was based on the particular pattern of injury and soft tissue involvement. The minimum follow-up duration was set at six months. The outcomes included the rate of union, primary nerve palsy recovery, secondary nerve damage, infection and revision surgery.ResultsBetween 2006 and 2014, 58 patients (mean age, 59.9; range, 19–97 years) with humeral midshaft fractures were treated with anterior (n = 33) or posterior (n = 25) plate fixation. After a mean follow-up duration of 34 months, 57 of 58 fractures achieved union after index procedure. Twelve fractures were associated with primary radial nerve palsy. Ten of the twelve patients with primary radial palsy recovered completely within six months after the index surgery. In total, one patient developed secondary palsy after anterior plating, and three patients developed secondary palsy after posterior plating. No significant difference in the healing rate (p = 0.4), primary nerve palsy recovery rate (p = 0.6) or prevalence of secondary nerve palsy (p = 0.4) was found between the two clinical groups. No cases of infection after plate fixation were documented.ConclusionsOpen reduction and internal fixation using an anterior approach with plate fixation provides a safe alternative to posterior plating in the treatment of humeral shaft fractures. An anterior approach allows supine positioning of the patient and yields union and complication rates comparable to those of a posterior approach with plate fixation for the treatment of humeral shaft fractures.

Surgical approach for fracture of distal humerus: Posterior <em>vs</em> lateral

“…12 The DASH Score, used in the half of the studies analyzed but the value is available only in two papers, is higher in patients treated with posterior approach than the ones treated with lateral approach: that means better functional results in patients treated with the posterior one. 13,15 After surgery, the ROM of the elbow in patients treated with lateral approach was: 134.2° (range: 131.5-139.2; SD: 4.31) of flexion and 2.4° (range: 0-4.2; SD: 2.16) of extension. While, the average ROM of the elbow in patients treated with posterior approach was: 135.9° (range: 125-145; SD:10.13) of flexion and 4.03° (range: 0-7.1; SD: 3.62) of extension.…”

“…Overall, 148 Patients have been treated with lateral or anterolateral approach, 11 , 12 , 15 , 16 , 17 while 117 have been treated with posterior approach. 12 , 13 , 14 , 15 A Subgroup of 20 patients underwent posterolateral combined approach. 16 …”

“…The DASH Score, used in the half of the studies analyzed but the value is available only in two papers, is higher in patients treated with posterior approach than the ones treated with lateral approach: that means better functional results in patients treated with the posterior one. 13 , 15 …”

“…The same advantage can be obtained in the combined anterolateral and lateral approach, also in this case without particular differences in terms of complications and functional outcomes. 13 Nowadays, the aesthetic impact and also the respect of soft tissues have not inconsiderable part in the good success of the performed surgical procedure. This is why MIPO procedures are becoming more and more popular.…”

A Retrospective Analysis of Plate Fixation of Humerus Fracture

“…Although plate fixation has the advantage of lesser rates of malunion and non-union, it causes soft tissue disruption, more blood loss and there are higher chances of infection and radial nerve damage with an open plating procedure [13,14]. Union was defined as a radiologically detectable callus bridge or at least three visible cortices on the radiographs [15]. Depending on the type of callus formation,…”