Minimally invasive plate osteosynthesis for humerus diaphyseal fractures (original) (raw)
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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.
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.
Introduction: The two methods of treatment of humeral shaft fractures, namely minimally invasive plate osteosynthesis (MIPO), and antegrade intramedullary nailing (IMN) are reported as satisfactory procedures. Objective: To compare the clinical and radiological results of MIPO and IMN techniques in surgical treatment of mid humeral shaft fractures. Patients and methods: From March 2017 to July 2018, a prospective study on 60 patients with closed unilateral mid-humeral shaft fractures were surgically treated with MIPO or IMN. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes (clinically and radiologically) were recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Complications in both groups have been reported. The follow-up duration ranged from 6 to 12 months with a mean duration of 6.7 months. Results: For group 1 having MIPO technique, the average operative time was 90.3 min (range 50-110), while mean blood loss was 167 ml (range 120-200). In group II patients (interlocking humeral nail), the average time of operation was 100.1 min (range 65-120), and mean blood loss was 118 ml (range 90-150). The mean Constant-Murley shoulder score was 86.95±15.7 in MIPO group and 88.75±13.7in IMN group. The mean Mayo Elbow Performance score in MIPO and IMN groups was 96.5 ± 5.87 and 95.8 ± 6.77, respectively. Radiologic bony union was achieved in 29 out of 30 patients in MIPO group and in 28 out of 30 in IMN group. All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in both groups. Shoulder impingement was found in 2 patients in IMN group. There was no statistically significant difference between two groups in all indexes mentioned above. Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.
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.
Musculoskeletal Surgery, 2017
Background The aim of our work is to evaluate and critically analyze long-term clinical and radiological data of a new unilateral external fixator (MIKAI KIT FEPÓ-Mikai S.p.A, Genoa, Italy), in the treatment of humeral shaft fractures. Materials and methods We reviewed 47 patients affected by humeral fractures that underwent surgery from July 2010 to March 2016 with unilateral external fixator. Demographic characteristics of the patients were recorded, which included age, sex and baseline comorbidities and mechanism of injury. Surgical data such as time of surgery and time of fixation according to AO-type of fracture, clinical objective and subjective outcomes were collected. Results The mean follow-up was 50.4 months (range 12-74). The patients' average age was 41.8 years (range 14-92). Mean surgical time was 66.8 (±37.7 min); and mean time of fixation was 4.5 (±1.7 months). We observed five delayed union (10.6%); one refracture (2.1%); and one case of non-union (2.1%) who underwent a revision surgery with nailing. No malunion was detected. Average quick-DASH was 11.7 (±14.8). The mean Constant Score at final follow-up was 81.5 (±14). 95.8% of patients were satisfied of our treatment. According to SF-12 scores, we observed 44 (93.6%) good results and 3 (6.4%) poor results. Conclusion We suggest the use of MIKAI KIT FEPÓ as a feasible option in the treatment of humeral shaft fractures. We reported optimal clinical and radiological outcomes at long-term follow-up. We advocate more powerful evidence to validate this new possible approach.
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.
Less Invasive Plate Osteosynthesis in Humeral Shaft Fractures
Operative Orthopädie und Traumatologie, 2009
Stable internal fixation of the humeral shaft by less invasive percutaneous plate insertion using two separate (proximal and distal) incisions, indirect reduction by closed manipulation and fixation to preserve the soft tissue and blood supply at the fracture zone. Early mobilization of the shoulder and elbow to ensure a good functional outcome. Indications Humeral shaft fractures (classified according to AO classification as: 12-A, B, C). Humeral shaft fractures extending to the proximal or distal shaft, small or deformed medullary canal or open growth plate. Contraindications Humeral shaft fractures with primary radial nerve palsy. Proximal humeral shaft fractures extending to the humeral head. Distal humeral fractures extending to the elbow joint.
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...
Chirurgie de la Main, 2015
The aim of this study was to evaluate the clinical, radiographic, and functional outcomes of a cohort of patients with distal third humeral shaft fractures treated using a posterior minimally invasive plate osteosynthesis (MIPO) technique. Twenty-one patients were retrospectively evaluated, 13 men and 8 women with an average age of 37 years. The surgery was performed through two posterior incisions away from the fracture site. The radial nerve was identified and protected. The fracture was fixed with a narrow 4.5/5.0 mm locking compression plate. After an average follow-up of 22 months, flexion-extension of the elbow was 1388 AE 78, with a range of motion of 1318. Shoulder motion was 1608 in forward flexion, 598 in external rotation, and internal rotation was to the spinous process of 9th thoracic vertebra. Pain severity was 0.5 on the VAS. The DASH score was 9. Average Constant score was 84. MEPI was 97. Fracture union was obtained in all patients. One patient developed transient postoperative radial nerve palsy. These results demonstrate that the posterior MIPO technique is a reliable option for treating distal third humeral shaft fractures. Level of evidence. -4. # 2015 Published by Elsevier Masson SAS.
Nonoperative treatment of humeral shaft fractures revisited
2015
PURPOSE The purpose of this study was to examine the union rate of humeral shaft fractures treated nonoperatively and to establish whether a particular fracture type is more likely to go on to nonunion. METHODS Radiographs and patient records of 207 humeral shaft fractures occurring during 5 years were retrospectively reviewed. All patients were initially managed nonoperatively and placed in a U-slab on diagnosis in the emergency department; this was converted to a functional humeral brace at 7 to 10 days after injury. Fracture location, morphology and comminution were assessed radiologically. Union was defined as the absence of pain and movement at the fracture site in the presence of radiographic callus formation. Nonunion was defined as no evidence of bone union by 1 year after injury or fractures requiring delayed fixation, defined as operative fixation undertaken more than 6 weeks after injury. RESULTS The study included 138 humeral shaft fracture patients; 18 patients (11%) we...