Preoperative position and protection of radial nerve by B-ultrasound combined with MIPPO for treatment of middle-inferior humerus fractures

Abstract

Background and purpose Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures. Methods The data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B). Results All the cases were followed up for 12–34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group. Conclusion MIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.

3D printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures

“…Iatrogenic radial nerve injury has been reported in 2.7%-20% of humeral shaft fractures, and is mainly associated with insufficient exposure and excessive traction [ 24 ]. In our recent study, we found that preoperative precise positioning using ultrasound and intraoperative pull methods reduced iatrogenic radial nerve injury, thereby increasing the efficiency of MIPO [ 25 ]. Additionally, the radial nerve passes through the posterior aspect to anterolateral at an average of 14 cm from the humeral lateral epicondyle [ 26 ].…”

3D printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures

“…This may be attributed to its xed position in the radial sulcus and direct contact with the humeral periosteum after passage through the medial intermuscular septum. Our recent study inclined that preoperative precise positioning by B-ultrasound and intraoperative pull method reduced iatrogenic injury of the radial nerve, thereby increasing the e ciency of MIPO [25]. However, the radial nerve passes through the posterior aspect to anterolateral at an average of 14 cm from the humeral lateral epicondyle [26].…”