Minimally invasive percutaneous lateral plate osteosynthesis in humeral shaft fractures.
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Published:
Aug 6, 2016
Keywords:
Fracture, Humerus, MIPO, Minimally invasive osteosynthesis.
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Abstract
Introduction: The aim of this study is to retrospectively assess functional and radiological outcomes, and immediate and long term postsurgical complications in a series of patients with humeral fractures treated with osteosynthesis with minimally invasive technique.Material and Methods: Retrospective Multicentric study of 14 patients with humeral fractures treated with minimally invasive plate osteosynthesis through lateral approaches between 2007 and 2013. Seven were females and 7 males, age averaged 48.7 years (range 21 -73). Fractures were classified according to the AO classification A1 12 n: 1; 12 B1 n: 1; 12B2 n: 3; C1 n 12: 6; 12C2 n: 1; 12C3 n: 2. Two lateral incisions were used proximal and distal. The plates were slid submuscular, and the radial nerve was protected. Results: Follow - up averaged 30 months.Union was achieved in 13 cases (92.85%), time to union averaged three months (range, 2 to 6). Flexion averaged 174.8 °, external rotation 67.2°, abduction 173.8º and internal rotation 72.1°. Elbow flexion and extension ROM averaged 140.5 °. Constant´s score averaged 82.66 points; DASH score averaged 15.27 points. Four patients had radial nerve neurapraxia (23.5%). Discussion: Percutaneous osteosynthesis with plates using a lateral minimally invasive approach has proven effective for the treatment of humeral shaft fractures, applying the principle of bridge plate. It is a biological procedure, technically demanding, and not exempt of complications.
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Ruchelli, L. S., Allende Nores, C. A., Gutierrez Olivera, N., Capomassi, M. A., & Gardenal, M. R. (2016). Minimally invasive percutaneous lateral plate osteosynthesis in humeral shaft fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(3), 213-218. https://doi.org/10.15417/471
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Clinical Research
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2- Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH. Compression platingversus intramedullary nailing of humeral shaft fractures—a meta-analysis. ActaOrthop 2006; 77: 279–84.y Suppl 33:19–27
3- Sarmiento A, Kinman PB, Galvin EG, et al. Functional bracing of fractures of the shaft of the humerus. J BoneJointSurg Am. 1977; 59:596–601.
4-Matt Walker, MDa, Brian Palumbo.Humeral shaft fractures: a review.J Shoulder Elbow Surg 2011;20: 1-12
5- Pablo R. Rupenian. Osteosíntesis mínimamente invasiva con placa .en fracturas diafisarias de húmero.Rev Asoc Argent Ortop Traumatol.2013 Vol. 78, pp. 53-63
6- Mario Rancan, Michael Dietrich, Tenzin Lamdark, Uenal Can, Andreas Platz. Minimal invasive long PHILOS1-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury, Int. J. Care Injured 41 (2010) 1277–1283
7- Helfet DL, Shonnard PY, Levine D, et al. Minimally invasive plate osteosynthesis of distal fracture of the tibia.Injury. 1997;28(suppl 1): 42–48.
8- Krettek C, Gerich T, Miclau T. A minimal invasive medial approach for proximal tibia fractures. Injury. 2001; 32(suppl 1):4–13.
9- Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report.Injury. 2005;36:530–538.
10- Kennedy CA, Beaton DE, Solway S, McConnell S, Bombardier C. Disabilities of the Arm, Shoulder and Hand (DASH). The DASH and QuickDASH Outcome Measure User’s Manual, Third Edition. Toronto, Ontario: Institute for Work & Health, 2011
11- Zhiquan A, Bingfang Z, Yeming Q, et al. Minimally invasive plating osteosynthesis of middle and distal third humeral shaft fractures. J Orthop Trauma. 2007;21:628–633.
12-Sarmiento A, Waddell JP, Latta LL: Diaphyseal humeral fractures: treatment options.
Instr Course Lect 2002; 51:257–269
13- Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis: does percoutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 1999; 13: 401-6.
14- Kleinig R, Hax PM. Die interne Uberbruckungsosteosyntheseohne Reposition des Stuckbruchbereichesals Alternative zurinternenFragmentfixation
vonStuckbruchennachanatomischer Reposition. Hefte Unfallheilkd1980;153:213-8.
15- Thielemann FW, Blersch E, Holz U. Plate osteosynthesis of femoral shaft fracture with reference to biological aspects. Unfallchirurg 1988;91:389-94.
16- . Ganz R, Mast J, Weber B, Perren S. Clinical aspects of “bio-logical” plating. Injury 1991;22:4-5.
17- . Mast JW, Jakob R, Ganz R. Planning and reduction technique in fracture surgery. Berlin, etc: Springer-Verlag, 1989.
18- Leunig M, Hertel R, Siebenrock KA, et al. The evolution of indirect reduction techniques for the treatment of fractures. ClinOrthop 2000;375:7-14
19- Gautier E1, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003 Nov;34 Suppl 2:B63-76.
20- Burkhead WZ, Scheinberg RR, Box G. Surgical anatomy of the axillary nerve. J Shoulder Elbow Surg. 1992;1:31–36.
21- Gardner MJ, Griffith MH, Dines JS, et al. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res. 2005;434:123–129
22- Vathana P, Chiarapattanakom P, Ratanalaka R, et al. The relationship of the axillary nerve and the acromion. J Med Assoc Thai. 1998;81: 953–957.
23- Cetik O, Uslu M, Acar HI, et al. Is there a safe area for the axillary nerve in the deltoid muscle? A cadaveric study. J Bone Joint Surg Am. 2006;88: 2395–2399.
24- Smith J, Berry G, Laflamme Y, et al. Percutaneous insertion of a proximal humeral locking plate: An anatomic study. Injury. 2006;[Epub ahead of print]
25- 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. IntOrthop 2009;33:543-7.
26- Jiang R, Luo CF, Zeng BF, Mei GH. Minimally invasive plating for complexhumeral shaft fractures. Arch Orthop Trauma Surg 2007;127:531–5.
27- Gallucci G, Vujovich A, Boretto J et al. Técnica mínimamente invasiva por vía posterior para el tratamiento de fracturas diafisarias de húmero. Rev Asoc Argent Ortop Traumatol Vol. 78, pp. 64-73.