Posterior Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures

Abstract

Fractures of the humeral shaft are common. Most of them can be successfully treated without surgery. In some cases, an operative intervention may offer faster and better functional results. One of the major problems with the open plating osteosynthesis is the extensive soft tissue stripping and disruption of periosteal circulation, caused by extensive surgical exposure, resulting in a relatively high rate of nonunion. Minimally invasive plate osteosynthesis (MIPO) techniques were developed to achieve a biologic fixation, although minimizing the complications of an open reduction. The incisions are small and remote from the fracture site to avoid direct fracture exposure. Thereby, MIPO technique obtains, theoretically, higher rates of union, lower infection risk, and decreases the need for bone graft. In the last years, MIPO has gained popularity with satisfactory clinical outcomes in the treatment of long bone fractures, especially in lower extremity. MIPO for humeral shaft fractures, however, could be a surgically dangerous procedure because of the risk of radial nerve injury. It was described by anterior and lateral approach. Humeral middle shaft fractures are possible to treat with a MIPO technique through an anterior, lateral, or a posterior approach. However, when the fracture is near the olecranon fossa, anterior approach is not possible as there is not enough space in the distal fragment to insert the amount of screws required to achieve stability. In this case, the posterior approach may be a good option for treatment. This article describes the MIPO technique through a posterior approach for the treatment of humeral shaft fractures.

Posterior minimally invasive plate osteosynthesis (MIPO) of distal third humeral shaft fractures with segmental isolation of the radial nerve

“…The surgical technique has been described previously [9]. A proximal incision approximately 5 cm in length was made in the posterior aspect of the arm, 10 cm distal to the acromial angle.…”

“…Multiple reports have been published on this technique [3][4][5][6][7][8], including use of the posterior MIPO technique for treating fractures in the middle and distal thirds of the humeral shaft [9]. In a middle-third humeral shaft fracture, the radial nerve does not need to be identified when using an anterior approach; however, it must always be identified when using a posterior approach.…”

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

“…The small number of patients does not allow for exhaustive conclusions about the safety of the technique and the real risk of iatrogenic radial nerve injury. 18 Surely, the aesthetic impact is significantly better, although there are no particular advantages in terms of function and quality of life. In fact, we believe that even traditional posterior access, as it is posterior, does not cause particular discomfort to the patient as it is not easily visible to him/her.…”

Best care paradigm to optimize functionality after extra-articular distal humeral fractures in the young patient

“…This was recently compared to traditional open reduction internal fixation in a large series of mid-distal humerus fractures, with findings of shorter union time and equivalent complication rates in the MIPO group. [56][57][58]…”