Minimally invasive plate osteosynthesis through a posterior approach for humeral shaft fractures
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Published:
Aug 1, 2013
Keywords:
MIPO, Humeral fractures, Shaft fractures, Radial nerve
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Abstract
BackgroundTo report the MIPO technique through a posterior approach for the treatment of humeral shaft fractures, and to evaluate the clinical and radiographic outcomes of a series of patients treated with this procedure.MethodsEleven patients were evaluated (9 men and 2 women; mean age, 33 years old). Ten fractures were closed and one open. The surgical technique is described in detail. The follow-up was 22 months.ResultsElbow flexo-extension was 140º-0°. Shoulder motion was: 170° of elevation, 70° of external rotation and internal rotation of D9. Pain (VAS): 0, MEPS: 96 points, UCLA test: 33 points. All fractures healed. Normal alignment of the shaft fracture was evidenced in 3 patients, a varus angulation was observed in 7 and a valgus angulation in one patient. Radial postoperative palsy was noted in one patient and another required implant removal due to an hematogenous infection.ConclusionsThis technique represents a reliable therapeutic option for any middle and distal shaft fractures. It is particularly useful in fractures of the distal diaphysis when the line of fracture is near the olecranon fossa since, in these cases, the MIPO through an anterior approach is not feasible. Good results are similar to those reported in the MIPO technique through the anterior or lateral approach.
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Gallucci, G., Vujovich, A., Boretto, J. G., Alfie, V., Donndorff, A., & De Carli, P. (2013). Minimally invasive plate osteosynthesis through a posterior approach for humeral shaft fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(2), 64-73. https://doi.org/10.15417/245
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Clinical Research
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References
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10. Krettek C, Gerich T, Miclau T. A minimal invasive medial approach for proximal tibia fractures. Injury 2001;32:4-13.
11. Smejkal K, D dek T, Zvák I, Trlica J, Lochman P. Minimally invasive plate osteosynthesis (MIPO) in the humeral diaphysis fractures. Int Orthop 2010;34:1297-1305.
12. Wang ZH, Xiang M, Xie J, Tang HC, Chen H, Liu X. Treatment of humerus shaft fractures using minimally invasive percutaneous plate osteosynthesis through anterior approach. Injury 2010;41:169-72.
13. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007;21:628-33.
14. Kobayashi M, Watanabe Y, Matsushita T. Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma 2010;24:212-6.
15. Ji F, Tong D, Tang H, Cai X, Zhang Q, Li J, Wang Q. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop 2009;33:543-7.
16. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE, Järvinen MJ. Functional treatment of closed humeral shaft fractures. Int Orthop 2005;29:10-3.
17. Ajmal M, O’Sullivan M, McCabe J, Curtin W. Antegrade locked intramedullary nailing in humeral shaft fractures. Injury 2001;32:692-4.
18. Vander GR, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am 1986;68:430-3.
19. Dabezies EJ, Banta CJ 2nd, Murphy CP, d’Ambrosia RD. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma 1992;6:10-3.
20. Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 2005;19:43-7.
21. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury 2004;35:587-95.
22. Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury 2005;36:75-80.
23. Rupenian P, Lebas G, Razza F, Herrador M, D´Assaro O. Osteosíntesis mínimamente invasiva con placa helicoidal en fracturas diafisarias del húmero con compromiso del tercio proximal. Rev Asoc Argent Ortop Traumatol 2005;70:252-5.
24. Oh CW, Byun YS, Oh JK, Kim JJ, Jeon IH, Lee JH, et al. Plating of humeral shaft fractures: comparison of standard conventional plating versus minimally invasive plating. Orthop Traumatol Surg Res 2012;98:54-60.
25. 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;86:346-59.
26. Apivatthakakul T, Patiyasikan S, Luevitoonvechkit S. Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study. Int Orthop 2010;41:169-72.
27. 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;34:131-5.
28. Shin SJ, Sohn HS, Do NH. Minimally invasive plate osteosynthesis of humeral shaft fracture: A technique to aid fracture reduction and minimize complications. J Orthop Trauma 2012;26:585-90.
29. An Z, Zeng B, He X, Huang P. Treatment of mid-distal humeral shaft fractures associated with radial nerve palsy using minimally invasive plating osteosynthesis technique. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008;22:513-5.
30. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? Int Orthop 2010;34:1297-1305.
2.Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am 1977;59:596-601.
3.Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg 2002;11:143-50.
4.Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 2000;14:162-6.
5.McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br 2000;82:336-9.
6.Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-1110.
7.Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis and vascularity: Preliminary results of a cadaver injection study. Injury 1997;28:7-12.
8.Flinkkilä T, Hyvönen P, Lakovaara M, Linden T, Ristiniemi J, Hämäläinen M. Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 1999;70:133-6.
9.Rommens PM, Blum J, Runkel M. Retrograde nailing of humeral shaft fractures. Clin Orthop Relat Res 1998;350:26-39.
10. Krettek C, Gerich T, Miclau T. A minimal invasive medial approach for proximal tibia fractures. Injury 2001;32:4-13.
11. Smejkal K, D dek T, Zvák I, Trlica J, Lochman P. Minimally invasive plate osteosynthesis (MIPO) in the humeral diaphysis fractures. Int Orthop 2010;34:1297-1305.
12. Wang ZH, Xiang M, Xie J, Tang HC, Chen H, Liu X. Treatment of humerus shaft fractures using minimally invasive percutaneous plate osteosynthesis through anterior approach. Injury 2010;41:169-72.
13. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007;21:628-33.
14. Kobayashi M, Watanabe Y, Matsushita T. Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma 2010;24:212-6.
15. Ji F, Tong D, Tang H, Cai X, Zhang Q, Li J, Wang Q. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop 2009;33:543-7.
16. Toivanen JA, Nieminen J, Laine HJ, Honkonen SE, Järvinen MJ. Functional treatment of closed humeral shaft fractures. Int Orthop 2005;29:10-3.
17. Ajmal M, O’Sullivan M, McCabe J, Curtin W. Antegrade locked intramedullary nailing in humeral shaft fractures. Injury 2001;32:692-4.
18. Vander GR, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am 1986;68:430-3.
19. Dabezies EJ, Banta CJ 2nd, Murphy CP, d’Ambrosia RD. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma 1992;6:10-3.
20. Levy JC, Kalandiak SP, Hutson JJ, Zych G. An alternative method of osteosynthesis for distal humeral shaft fractures. J Orthop Trauma 2005;19:43-7.
21. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury 2004;35:587-95.
22. Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury 2005;36:75-80.
23. Rupenian P, Lebas G, Razza F, Herrador M, D´Assaro O. Osteosíntesis mínimamente invasiva con placa helicoidal en fracturas diafisarias del húmero con compromiso del tercio proximal. Rev Asoc Argent Ortop Traumatol 2005;70:252-5.
24. Oh CW, Byun YS, Oh JK, Kim JJ, Jeon IH, Lee JH, et al. Plating of humeral shaft fractures: comparison of standard conventional plating versus minimally invasive plating. Orthop Traumatol Surg Res 2012;98:54-60.
25. 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;86:346-59.
26. Apivatthakakul T, Patiyasikan S, Luevitoonvechkit S. Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study. Int Orthop 2010;41:169-72.
27. 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;34:131-5.
28. Shin SJ, Sohn HS, Do NH. Minimally invasive plate osteosynthesis of humeral shaft fracture: A technique to aid fracture reduction and minimize complications. J Orthop Trauma 2012;26:585-90.
29. An Z, Zeng B, He X, Huang P. Treatment of mid-distal humeral shaft fractures associated with radial nerve palsy using minimally invasive plating osteosynthesis technique. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008;22:513-5.
30. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? Int Orthop 2010;34:1297-1305.