Belangero-Livani Technique (MIPO) in the Treatment of Humeral Shaft Fractures. A Latin American Experience in Three Medical Centers
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Published:
Aug 31, 2022
Keywords:
Humeral shaft fracture, internal fixation, MIPO technique
Main Article Content
Abstract
Objective: To determine the demographic data of the patients in relation to age, sex, profession, affected side, single or multiple lesions, type of material used, bone healing time and possible complications of the treatment of diaphyseal fractures of the humerus treated using the MIPO technique in a series of patients from three hospital units in Ecuador, Paraguay, and Brazil.
Materials and Methods: A retrospective, longitudinal, observational study of data from 133 patients collected in 3 services in Quito, Ecuador; Asunción, Paraguay; and Passo Fundo, Brazil. The distributions between different services were compared using Pearson’s chisquare test.
Results: The age of the patients ranged from 17 to 76 years, with a mean of 36 years. The median time to union, which occurred in 126 of the 132 patients, was 11 weeks. Most of the patients were male (70.45%), the right side was the most affected (55.3%), most of the fractures were single (85.61%), consolidation occurred in 95.45 % of cases, complications occurred only in 9.09% of patients, 6.82% of them were severe. In relation to complications, they were divided according to the absence (87.12%) or presence of the following: post-surgical neuropraxia (0.76%), infection (3.03%), and pseudarthrosis (4.55%).
Conclusion: The MIPO technique for the treatment of diaphyseal fractures of the humerus presents low rates of complications and morbidity, demonstrating good rates of consolidation.
Materials and Methods: A retrospective, longitudinal, observational study of data from 133 patients collected in 3 services in Quito, Ecuador; Asunción, Paraguay; and Passo Fundo, Brazil. The distributions between different services were compared using Pearson’s chisquare test.
Results: The age of the patients ranged from 17 to 76 years, with a mean of 36 years. The median time to union, which occurred in 126 of the 132 patients, was 11 weeks. Most of the patients were male (70.45%), the right side was the most affected (55.3%), most of the fractures were single (85.61%), consolidation occurred in 95.45 % of cases, complications occurred only in 9.09% of patients, 6.82% of them were severe. In relation to complications, they were divided according to the absence (87.12%) or presence of the following: post-surgical neuropraxia (0.76%), infection (3.03%), and pseudarthrosis (4.55%).
Conclusion: The MIPO technique for the treatment of diaphyseal fractures of the humerus presents low rates of complications and morbidity, demonstrating good rates of consolidation.
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How to Cite
Enriquez Romo, P., Palacios Fantilli, J., Faiad Piluski, P. C., Castillo Rodriguez, C. H., & Lech, O. (2022). Belangero-Livani Technique (MIPO) in the Treatment of Humeral Shaft Fractures. A Latin American Experience in Three Medical Centers. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 476-487. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1498
Section
Clinical Research
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References
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fixation of diaphyseal humeral fractures using the minimally invasive bridge-plate technique. Rev Bras Ortop 2015; 47(3):310-7. Disponible en: https://www.scielo.br/j/rbort/a/bpcQm3qC8dGXtsQ9CjSCHxv/?format=pdf&lang=en
2. Matsunaga FT, Tamaoki MJS, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally invasive osteosynthesis
with a bridge plate versus a functional brace for humeral shaft fractures. J Bone Joint Surg Am 2017;99(7):583-92.
https://doi.org/10.2106/JBJS.16.00628
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4. Mahajan AS, Kim YG, Kim JH, D’sa P, Lakhani A, Ok HS. Is anterior bridge plating for mid-shaft humeral
fractures a suitable option for patients predominantly involved in overhead activities? A functional outcome study in athletes and manual laborers. Clin Orthop Surg 2016;8(4):358-66. https://doi.org/10.4055/cios.2016.8.4.358
5. Livani B, Belangero W, Andrade K, Zuiani G, Pratali R. Is MIPO in humeral shaft fractures really safe?
Postoperative ultrasonographic evaluation. Int Orthop 2009:33(6):1719-23. https://doi.org/10.1007/s00264-008-0616-x
6. Hadhoud MM, Darwish AE, Mesriga MM. Minimally invasive plate osteosynthesis versus open reduction and plate fixation of humeral shaft fractures. Menoufia Med J 2015;28:154-61. https://doi.org/10.4103/1110-2098.155974
7. Claessen FMAP, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after
operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg 2015;24(11):e307-e311.
https://doi.org/10.1016/j.jse.2015.07.012
8. Zogaib RK, Morgan S, Belangero PS, Fernandes HJA, Belangero WD, Livani B. Minimal invasive osteosynthesis
for treatment of diaphyseal transverse humeral shaft fractures. Acta Ortop Bras 2014;22(2):94-8.
https://doi.org/10.1590/1413-78522014220200698
9. Esmailiejah AA, Abbasian MR, Safdari F, Ashoori K. Treatment of humeral shaft fractures: Minimally invasive
plate osteosynthesis versus open reduction and internal fixation. Trauma Mon 2015;20(3):e26271.
https://doi.org/10.5812/traumamon.26271v2
10. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury 2004;35(6):587-95.
https://doi.org/10.1016/j.injury.2003.12.003
11. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 2005;36(4):530-8.
https://doi.org/10.1016/j.injury.2004.05.036
12. Ruiz Giolo S. Introdução à análise de dados categóricos comaplicações. São Paulo, Brasil: Editora Blucher; 2017.
13. Giordano M, Giordano V, Gameiro VS, Belangero W, Livani B, Giannoudis PV, et al. Anterior minimally invasive
plating osteosynthesis technique (MIPO) for humeral shaft fractures: an anatomical study of neuromuscular
structures at risk. Eur J Orthop Surg Traumatol 2020;31(3):449-58. https://doi.org/10.1007/s00590-020-02792-2
14. Zhang Q, Sun N, Huang Q, Zhu S, Wu X. Minimally invasive plating osteosynthesis in the treatment of humeral
shaft fractures: A meta-analysis. J Invest Surg 2017;30(2):133-42. https://doi.org/10.1080/08941939.2016.1215581
15. Yu B, Liu L, Yang G, Zhang L, Lin X. Comparison of minimally invasive plate osteosynthesis and conventional plate osteosynthesis for humeral shaft fracture. Medicine (Baltimore) 2016;95(39):e4955. https://doi.org/10.1097/MD.0000000000004955
16. Malhan S, Thomas S, Srivastav S, Agarwal S, Mittal V, Nadkarni B, et al. Minimally invasive plate osteosynthesis using a locking compression plate for diaphyseal humeral fractures. J Orthop Surg 2012;20(3):292-6. https://doi.org/10.1177/230949901202000305
17. Benegas E, Ferreira Neto AA, Conforto Gracitelli ME, Malavolta EA, Assunção JH, De Santis Prada F, et
al. Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial
comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis. J Shoulder Elbow Surg
2014;23(6):767-74. https://doi.org/10.1016/j.jse.2014.02.010
18. Paris H, Tropiano P, Clouet D’orval B, Chaudet H, Poitout DG. [Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature]. Rev Chir Orthop Reparatrice Appar Mot 2000;86(4):346-59. PMID: 10880934
19. Tetsworth K, Hohmann E, Glatt V. Minimally invasive plate osteosynthesis of humeral shaft fractures: Current state of the art. J Am Acad Orthop Surg 2018;26(18):652-61. https://doi.org/10.5435/JAAOS-D-17-00238
20. Zhao JG, Wang J, Meng XH, Zeng XT, Kan SL. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials. PLoS One 2017;12(3):e0173634. https://doi.org/10.1371/journal.pone.0173634
21. Lee T, Yoon J. Newly designed minimally invasive plating of a humerus shaft fracture; a different introduction of the plate. Int Orthop 2016;40(12):2597-2602. https://doi.org/10.1007/s00264-015-3097-8
22. Wang C, Li J, Li Y, Dai G, Wang M. Is minimally invasive plating osteosynthesis for humeral shaft fracture
advantageous compared with the conventional open technique? J Shoulder Elbow Surg 2015;24(11):1741-8.
https://doi.org/10.1016/j.jse.2015.07.032
23. Kim Y-G, Park K-H, Kim J-W, Oh J-K, Yoon J-P, Kim, H-J, et al. Is minimally invasive plate osteosynthesis
superior to open plating for fixation of two-part fracture of the proximal humerus? J Orthop Surg 2019;27(2):2309499019836156. https://doi.org/10.1177/2309499019836156
24. Mehraj M, Shah I, Mohd J, Rasool S. Early results of bridge plating of humerus diaphyseal fractures by MIPO
technique. Ortop Traumatol Rehabil 2019;21(2):109-118. https://doi.org/10.5604/01.3001.0013.1915
fixation of diaphyseal humeral fractures using the minimally invasive bridge-plate technique. Rev Bras Ortop 2015; 47(3):310-7. Disponible en: https://www.scielo.br/j/rbort/a/bpcQm3qC8dGXtsQ9CjSCHxv/?format=pdf&lang=en
2. Matsunaga FT, Tamaoki MJS, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally invasive osteosynthesis
with a bridge plate versus a functional brace for humeral shaft fractures. J Bone Joint Surg Am 2017;99(7):583-92.
https://doi.org/10.2106/JBJS.16.00628
3. An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 2010;34(1):131-5. https://doi.org/10.1007/s00264-009-0753-x
4. Mahajan AS, Kim YG, Kim JH, D’sa P, Lakhani A, Ok HS. Is anterior bridge plating for mid-shaft humeral
fractures a suitable option for patients predominantly involved in overhead activities? A functional outcome study in athletes and manual laborers. Clin Orthop Surg 2016;8(4):358-66. https://doi.org/10.4055/cios.2016.8.4.358
5. Livani B, Belangero W, Andrade K, Zuiani G, Pratali R. Is MIPO in humeral shaft fractures really safe?
Postoperative ultrasonographic evaluation. Int Orthop 2009:33(6):1719-23. https://doi.org/10.1007/s00264-008-0616-x
6. Hadhoud MM, Darwish AE, Mesriga MM. Minimally invasive plate osteosynthesis versus open reduction and plate fixation of humeral shaft fractures. Menoufia Med J 2015;28:154-61. https://doi.org/10.4103/1110-2098.155974
7. Claessen FMAP, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after
operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg 2015;24(11):e307-e311.
https://doi.org/10.1016/j.jse.2015.07.012
8. Zogaib RK, Morgan S, Belangero PS, Fernandes HJA, Belangero WD, Livani B. Minimal invasive osteosynthesis
for treatment of diaphyseal transverse humeral shaft fractures. Acta Ortop Bras 2014;22(2):94-8.
https://doi.org/10.1590/1413-78522014220200698
9. Esmailiejah AA, Abbasian MR, Safdari F, Ashoori K. Treatment of humeral shaft fractures: Minimally invasive
plate osteosynthesis versus open reduction and internal fixation. Trauma Mon 2015;20(3):e26271.
https://doi.org/10.5812/traumamon.26271v2
10. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury 2004;35(6):587-95.
https://doi.org/10.1016/j.injury.2003.12.003
11. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 2005;36(4):530-8.
https://doi.org/10.1016/j.injury.2004.05.036
12. Ruiz Giolo S. Introdução à análise de dados categóricos comaplicações. São Paulo, Brasil: Editora Blucher; 2017.
13. Giordano M, Giordano V, Gameiro VS, Belangero W, Livani B, Giannoudis PV, et al. Anterior minimally invasive
plating osteosynthesis technique (MIPO) for humeral shaft fractures: an anatomical study of neuromuscular
structures at risk. Eur J Orthop Surg Traumatol 2020;31(3):449-58. https://doi.org/10.1007/s00590-020-02792-2
14. Zhang Q, Sun N, Huang Q, Zhu S, Wu X. Minimally invasive plating osteosynthesis in the treatment of humeral
shaft fractures: A meta-analysis. J Invest Surg 2017;30(2):133-42. https://doi.org/10.1080/08941939.2016.1215581
15. Yu B, Liu L, Yang G, Zhang L, Lin X. Comparison of minimally invasive plate osteosynthesis and conventional plate osteosynthesis for humeral shaft fracture. Medicine (Baltimore) 2016;95(39):e4955. https://doi.org/10.1097/MD.0000000000004955
16. Malhan S, Thomas S, Srivastav S, Agarwal S, Mittal V, Nadkarni B, et al. Minimally invasive plate osteosynthesis using a locking compression plate for diaphyseal humeral fractures. J Orthop Surg 2012;20(3):292-6. https://doi.org/10.1177/230949901202000305
17. Benegas E, Ferreira Neto AA, Conforto Gracitelli ME, Malavolta EA, Assunção JH, De Santis Prada F, et
al. Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial
comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis. J Shoulder Elbow Surg
2014;23(6):767-74. https://doi.org/10.1016/j.jse.2014.02.010
18. Paris H, Tropiano P, Clouet D’orval B, Chaudet H, Poitout DG. [Fractures of the shaft of the humerus: systematic plate fixation. Anatomic and functional results in 156 cases and a review of the literature]. Rev Chir Orthop Reparatrice Appar Mot 2000;86(4):346-59. PMID: 10880934
19. Tetsworth K, Hohmann E, Glatt V. Minimally invasive plate osteosynthesis of humeral shaft fractures: Current state of the art. J Am Acad Orthop Surg 2018;26(18):652-61. https://doi.org/10.5435/JAAOS-D-17-00238
20. Zhao JG, Wang J, Meng XH, Zeng XT, Kan SL. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials. PLoS One 2017;12(3):e0173634. https://doi.org/10.1371/journal.pone.0173634
21. Lee T, Yoon J. Newly designed minimally invasive plating of a humerus shaft fracture; a different introduction of the plate. Int Orthop 2016;40(12):2597-2602. https://doi.org/10.1007/s00264-015-3097-8
22. Wang C, Li J, Li Y, Dai G, Wang M. Is minimally invasive plating osteosynthesis for humeral shaft fracture
advantageous compared with the conventional open technique? J Shoulder Elbow Surg 2015;24(11):1741-8.
https://doi.org/10.1016/j.jse.2015.07.032
23. Kim Y-G, Park K-H, Kim J-W, Oh J-K, Yoon J-P, Kim, H-J, et al. Is minimally invasive plate osteosynthesis
superior to open plating for fixation of two-part fracture of the proximal humerus? J Orthop Surg 2019;27(2):2309499019836156. https://doi.org/10.1177/2309499019836156
24. Mehraj M, Shah I, Mohd J, Rasool S. Early results of bridge plating of humerus diaphyseal fractures by MIPO
technique. Ortop Traumatol Rehabil 2019;21(2):109-118. https://doi.org/10.5604/01.3001.0013.1915