Proximal humerus fractures (PHFs): comparison of functional outcome 1 year after minimally invasive plate osteosynthesis (MIPO) versus open reduction internal fixation (ORIF)

Abstract

Purpose Osteosynthetic treatment strategies of PHFs include MIPO or ORIF techniques. The aim of this study was to compare the 1 year outcome following either technique in type B PHFs. Methods This study was designed as a retrospective cohort study of patients treated at one academic Level 1 trauma center. Patients from 2009 to 2019 who required surgical treatment of a type B PHF were eligible to be included in this study. Patients with A- or C-type fractures or patients requiring arthroplasty were excluded. All patients were treated with Proximal Humerus Interlocking System (PHILOS) and stratified according the approach into Group MIPO or Group ORIF. Outcome measures include local complications that occurred during hospitalization, nonunion after 12 months, and range of motion after 1 year follow-up. Results This study included 149 (75.3%) patients in Group ORIF, and 49 (24.7%) in Group MIPO. The fracture morphology and concomitant injuries were comparable amongst these groups. When compared with Group MIPO, Group ORIF had a 2.6 (95% CI 0.6–11.7) higher risk of suffering from local complications. The rate of postoperative nerve lesions was comparable (OR 0.9, 95% CI 0.1–9.7) as was the rate of soft tissue complications (OR 2.0, 95% CI 0.2–17.2). The risk for nonunion was 4.5 times higher (95% 1.1–19.5) in Group ORIF when compared with Group MIPO. Group MIPO had a higher chance of flexion above 90° (OR 8.2, 95% CI 2.5–27.7). Conclusion This study provides indications that patients following surgical treatment of PHFs in MIPO technique might have favourable outcome. Large-scale and high-quality studies are warranted to confirm these results.

Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results?

“…All the studies included in this systematic review reported the complications that occurred in the DP and DS groups ( 5 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ). Overall, there were no differences in the number of complications: 121 in the DP group (28.4%) and 105 in the DS group (29.9%) ( P = n.s.).…”

“…A significantly higher incidence of screw cut-outs/implant loosening was documented in the MIPO group ( n = 36, 10.3%) compared to the ORIF group ( n = 25, 5.6%) ( P = 0.01). However, only five studies ( 27 , 30 , 32 , 34 , 37 ) took into account the complication rate for Neer PHFs type subgroups. Complications for Neer II fractures were described by two studies: out of 71 patients, the complication rate was 8.6% (3 out of 35 patients) in the DP group and 2.8% (1 out of 36 patients) in the DS group ( 30 , 34 ).…”

“…Complications for Neer II fractures were described by two studies: out of 71 patients, the complication rate was 8.6% (3 out of 35 patients) in the DP group and 2.8% (1 out of 36 patients) in the DS group ( 30 , 34 ). For Neer III fractures, four studies reported a complication rate of 10.5% in the DP group (22 out of 210 patients) and 11.1% (12 out of 108 patients) in the DS group ( 27 , 32 , 34 , 37 ). For Neer IV fractures, two studies reported the complication rate, but the sample size was very small, thus making the results poorly reliable: the complication rate was 69.2% (9 out of 13 patients) in the DP group and 53.8% (7 out of 13 patients) in the DS group ( 32 , 34 ).…”

Limb Fractures Treated With the Novel Plate Osteosynthesis Application Technique: Second to Minimally Invasive Plates osteosynthesis

“…This approach can minimize surgical trauma, alleviate postoperative pain, expedite the recovery process, and provide better cosmetic outcomes. 12 , 21 , 22 Indeed, research has shown that closed reduction is the greatest challenge in the MIPO technique. In addition, radiation exposure during the procedure is another factor that young orthopaedic physicians consider when opting for open reduction and internal fixation (ORIF) instead.…”

Displaced humeral head after intramedullary nailing for proximal humeral fracture is associated with worse short-term outcomes—a multicenter TRON study

“…We defined nonunion as the existence of a fracture line on the radiographic image obtained at the last follow-up as described in a previous report. 8 …”