Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

Abstract

Background: Minimally invasive plate osteosynthesis (MIPO) technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture.

Materials and methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively.

Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years). Twenty-seven of the thirty-two patients (84.3%) had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes) and mean radiation exposure was 160.3 seconds (range: 100-220 seconds). The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks). Shoulder function was excellent in 27 cases (84.3%) and good in remaining 5 cases (15.6%) on the UCLA score. Elbow function was excellent in 26 cases (81.2%), good in 5 cases (15.6%), and fair in 1 case (3.1%) who had an associated olecranon fracture that was fixed by tension band wire in the same sitting.

Conclusion: MIPO of the humerus gives good functional and cosmetic results and should be considered one of the management options in the treatment of humeral diaphyseal fractures.

Keywords: Minimally invasive plate osteosynthesis; diaphyseal fracture; humerus.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1A

(a) Preoperative X-ray of arm (anteroposterior and lateral view) showing fracture shaft of humerus (AO 1.2.A.2); follow-up X-ray (b) anteroposterior view and (c) lateral view at 6 months followup showing good union

Figure 1B

Postoperative clinical photographs of same patient showing (a) elbow flexion (b) elbow extension with healed surgical scars (c) shoulder abduction (d) shoulder internal rotation

Figure 2A

(a) Intraoperative image with two incisions and the template plate; (b) Intraoperative fluoroscopy image showing fracture shaft of humerus (AO 1.2.C.1); (c) Intraoperative fluoroscopy image showing manipulation technique to achieve reduction

Figure 2B

One-year follow-up X-ray of a patient showing good union but a varus alignment of 5°

Figure 2C

Clinical photograph showing in spite of the varus alignment, the patient has a good range of motion at the elbow