Minimally invasive plate osteosynthesis for humeral shaft fracture

A reproducible technique with the assistance of an external fixator

Hyun Joo Lee, Chang Wug Oh, Jong-Keon Oh, Theerachai Apivatthakakul, Joon Woo Kim, Jong Pil Yoon, Dong Joo Lee, Jae Wook Jung

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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. Results: There was no case of mal-union >10, and mean angulation was 1.3 (range 0 -9) in the coronal plane and 1.2 (range 0 -8) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3-38.4 weeks) and a mean follow-up of 20.8 months (range 13.5-31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation. Conclusions: Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates. Level of Evidence: IV

Original languageEnglish
Pages (from-to)649-657
Number of pages9
JournalArchives of Orthopaedic and Trauma Surgery
Volume133
Issue number5
DOIs
Publication statusPublished - 2013 May 1

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Humeral Fractures
External Fixators
Humerus
Radial Nerve
Wounds and Injuries
Risk Reduction Behavior
Elbow
Paralysis
Joints
Maintenance
Therapeutics

Keywords

  • External fixator
  • Humerus
  • MIPO
  • Shaft fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Minimally invasive plate osteosynthesis for humeral shaft fracture : A reproducible technique with the assistance of an external fixator. / Lee, Hyun Joo; Oh, Chang Wug; Oh, Jong-Keon; Apivatthakakul, Theerachai; Kim, Joon Woo; Yoon, Jong Pil; Lee, Dong Joo; Jung, Jae Wook.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 133, No. 5, 01.05.2013, p. 649-657.

Research output: Contribution to journalArticle

Lee, Hyun Joo ; Oh, Chang Wug ; Oh, Jong-Keon ; Apivatthakakul, Theerachai ; Kim, Joon Woo ; Yoon, Jong Pil ; Lee, Dong Joo ; Jung, Jae Wook. / Minimally invasive plate osteosynthesis for humeral shaft fracture : A reproducible technique with the assistance of an external fixator. In: Archives of Orthopaedic and Trauma Surgery. 2013 ; Vol. 133, No. 5. pp. 649-657.
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AU - Oh, Chang Wug

AU - Oh, Jong-Keon

AU - Apivatthakakul, Theerachai

AU - Kim, Joon Woo

AU - Yoon, Jong Pil

AU - Lee, Dong Joo

AU - Jung, Jae Wook

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N2 - 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. Results: There was no case of mal-union >10, and mean angulation was 1.3 (range 0 -9) in the coronal plane and 1.2 (range 0 -8) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3-38.4 weeks) and a mean follow-up of 20.8 months (range 13.5-31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation. Conclusions: Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates. Level of Evidence: IV

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KW - External fixator

KW - Humerus

KW - MIPO

KW - Shaft fracture

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