Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures (original) (raw)
Related papers
Trials, 2013
Background: Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace. Methods/Design: This randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs. Discussion: According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery). Trial registration: Current Controlled Trials: ISRCTN24835397
Surgical Update: International Journal of Surgery and Orthopedics, 2020
Introduction: Fracture of humeral shaft account for roughly 3% of all fractures. Previously, non-operative treatment has been accepted modality of treatment. Three main operative techniques are in vogue for treating displaced humeral shaft fractures namely intramedullary nailing, conventional plating osteosynthesis (CPO) and minimally invasive plate osteosynthesis (MIPO). Material and Methods: 40 fractures of humerus shaft were treated with MIPO technique, in a prospective study between December 2015 and September 2017 at our institute. The cases were followed up for a minimum period of 2 years. Results: The average age was 41 years (23-71 years). Twenty-three (57.5%) were males and 17 (42.5 %) females. Twentynine cases (72.5%) had injury in their dominant arm. The mean surgical time was 45.5 minutes and the mean radiation exposure was for 85.3 seconds. The mean follow-up of our cases was 33 months. Conclusion: MIPO is a better choice for treating humeral shaft fractures than CPO, though there is no significant difference between MIPO and CPO in terms of operative time, fracture union rate, and fracture union time.
Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?
International Orthopaedics, 2010
Background Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture. Methods Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique.
Minimally Invasive Plate Osteosynthesis of Humeral Shaft Fractures
Journal of the American Academy of Orthopaedic Surgeons, 2018
Most closed humeral shaft fractures can be successfully managed nonsurgically. However, fractures for which closed treatment is unsuccessful are stabilized using either plates or intramedullary nails. There are shortcomings associated with each technique, including the potential complications of nonunion, infection, shoulder pain, and radial nerve injury. Minimally invasive plate osteosynthesis (MIPO), an innovative alternative treatment, is gaining in popularity. This technique is based on the anterior humeral shaft providing a relatively safe surface for plate application, and limited open exposures proximally and distally allow percutaneous insertion of the necessary implant. More than 40 articles have been published regarding MIPO, and it compares favorably to other available forms of treatment with excellent functional outcomes and a lower rate of iatrogenic radial nerve injury. Larger randomized controlled trials comparing this method with other accepted techniques, including nonsurgical management, are necessary to better define the role of MIPO in the management of humeral shaft fractures.
Acta orthopaedica et traumatologica turcica, 2014
We aimed to evaluate the objective and subjective outcomes of humerus shaft fractures treated with minimal invasive percutaneous plate osteosynthesis and emphasize points which may enhance clinical outcomes and simplify the procedure. The retrospective study included 14 patients (mean age: 41.7 years; range: 19 to 66 years) with humerus mid-shaft fractures treated with the MIPPO technique between 2009 and 2011. 4.5-mm locking plates were applied via an anterior approach and advanced antegradely (proximal to distal) to protect the integrity of the deltoid insertion. Fracture healing was evaluated using plain radiographs. OBJECTIVE outcomes were assessed in terms of range of motion and subjective outcomes using the American Shoulder and Elbow Society (ASES), University of California, Los Angles (UCLA), Mayo Elbow Performance Index (MEPI) and The Disability of The Arm, Shoulder and Hand (DASH) scores. Satisfactory outcomes with successful union were obtained within a mean of 17.8 (rang...
Archives of Orthopaedic and Trauma Surgery, 2013
Background Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture. Methods Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique.
Acta Ortopédica …
INTRODUCTION Humeral shaft fractures are, in most cases, treated conser-vatively(1-3). However, there are absolute indications (multiple trauma, open fractures, pathological fractures, floating elbow, vascular injury, radial nerve palsy after closed reduction, pseu- ...
Humeral shaft fracture: systematic review of non-operative and operative treatment
Archives of Orthopaedic and Trauma Surgery
Introduction Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome. Methods Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc. Results A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84–92%), 94% (95% CI 92–95%) f...
Minimally invasive plate osteosynthesis for humerus diaphyseal fractures
Indian Journal of Orthopaedics, 2011
Background Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture. Methods Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique.
A study of outcomes of proximal humerus fractures treated with plate osteosynthesis
International Journal of Orthopaedics Sciences, 2017
Introduction: Proximal humerus fractures are the third most common non vertebral osteoporotic fracture after proximal femur and colles fractures, accounting for >10% of fractures, above the age of 65 years and has a 3:1 female predominance. Many different techniques have been used to treat displaced or comminuted proximal humerus fractures. However, many of these constructs are less stable than open reduction and internal fixation (ORIF) with locking plates. Locked plating has been shown to be an advancement over previous fixation techniques in that it allows for rigid fixation with low rates of fixation loss. Objective: The objective of this study was to 1) study outcomes of proximal humerus fractures treated with plate osteosynthesis (PHILOS plate or PHLP plate). 2) To establish the role of proximal humerus plate osteosynthesis in treatment of complex proximal humeral fractures. 3) To establish the role of proximal humeral locking plates in early mobilization. Materials and Methods: 44 patients with proximal humerus fractures were reviewed between from September 2011 to April 2016. They were randomized and treated with either proximal humerus interlocking system (PHILOS) or the proximal humerus locking plate after taking clearance from the ethical committee. Closed & compound fractures, 2/3/4 part in adults' more than 18 years, Fit and willing for surgery were included in the study. Patients with pathological fractures, distal neuro vascular deficit, immunosuppressive therapy, infection, poor general condition were excluded from study. Patients were followed up at 2 weeks, 6 weeks, 3 months and 6 months. Radiographs were taken to check position of plate and fracture healing. Patients were evaluated with NEER's shoulder scoring system at 3 & 6 months after radiological confirmation of fracture healing. Results: Out of 44 patients with proximal humerus fractures, 26 were treated with PHILOS and 18 with PHLP plate. The average time to union was 13.04 weeks in PHILOS and that for PHLP plate being 15.48 weeks. Rotator cuff was tied in 11 patients out of 44. Bone graft substitute was used only in 3 patients out of 44. The Neer's score in this study has consistently improved over time. At the end of 6 weeks it was 61.5 which then rose to 73 at end of 3 months. The average Neer's score in our study at end of final follow up at 6 weeks was 80.5 which falls into the satisfactory group. We observed 10 patients (22.7%) with complications which resulted in poor functional outcomes. The main complication observed in this study was shoulder stiffness seen in 8 patients. Conclusion: A reproducible standard surgical outcome is key to better functional outcome in patients with proximal humerus fractures. Rotator cuff tying leads to a better functional outcome as compared to those without rotator cuff repair. Also there has been an observed better outcome in more complex fractures. Hence this surgical technique can be advocated for routine surgical management of proximal humerus fractures.