COMPARISON OF EFFECTIVENESS BETWEEN ANTERIOR AND LATERAL APPROACHES OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS IN TREATMENT OF HUMERAL SHAFT FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HEXiaojian ¹ ,  PANFugen ¹ , ZHOUKaihua ¹ , ZHUANGJian ¹ , CHENMingji ¹ , ANZhiquan ²

1. Department of Orthopaedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, 201700, P. R. China;
2. Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiaotong University;

Corresponding author：

PANFugen, Email: pfg26229@163.com

Keywords：

Humeral shaft fracture; Minimally invasive plate osteosynthesis; Anterior approach; Lateral approach

DOI：

10.7507/1002-1892.20140091

Video：

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Objective To compare the effectiveness of anterior and lateral approaches of minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. Methods The clinical data were retrospectively analyzed and compared from 35 cases of humeral shaft fractures between January 2010 and December 2012. The patients underwent MIPO by anterior approach in 17 patients (group A) and by lateral approach in 18 patients (group B). There was no significant difference in gender, age, injury causes, type of fractures, and time from injury to operation between 2 groups (P>0.05). The operation time, fracture healing time, intra- or postoperative complications, and shoulder and elbow range of motion (ROM) values were recorded and analyzed. The functions of the affected shoulder and elbow were assessed with the University of California Los Angeles (UCLA) and Mayo elbow performance score system respectively. Results The operation time was (91.35±8.00) minutes and (95.56±7.92) minutes in groups A and B respectively, showing no significant difference (t=-1.561, P=0.128). Incision healed by first intention in all patients of 2 groups. No iatrogenic radial nerve palsy occurred in group A, 2 cases had postoperative iatrogenic radial nerve palsy in group B, showing no significant difference (P=0.486). The patients were followed up 15.4 months on average (range, 11-24 months) in group A and 16.8 months on average (range, 10-23 months) in group B. The X-ray films showed bony healing in all patients. The fracture union time was (13.5±2.1) weeks in group A and (14.0±2.2) weeks in group B, showing no significant difference (t=-0.696, P=0.491). The UCLA scores were 33.4±1.9 in group A and 30.6±2.0 in group B, and the Mayo elbow performance scores were 100 in group A and 96.4±2.8 in group B; all showed significant differences (t=4.231, P=0.000; t=5.293, P=0.000). Conclusion Good clinical outcomes could be obtained when humeral shaft fractures are treated with MIPO either by anterior approach or by lateral apporach. However, anterior approach could offer better shoulder and elbow functional results.

Citation： HEXiaojian, PANFugen, ZHOUKaihua, ZHUANGJian, CHENMingji, ANZhiquan. COMPARISON OF EFFECTIVENESS BETWEEN ANTERIOR AND LATERAL APPROACHES OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS IN TREATMENT OF HUMERAL SHAFT FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 401-405. doi: 10.7507/1002-1892.20140091 Copy

1.	Volgas DA, Stannard JP, Alonso JE. Nonunions of the humerus. Clin Orthop Relat Res, 2004, (419):46-50.
2.	Matsunaga FT, Tamaoki MJ, Matsumoto MH, et al. Treatment of the humeral shaft fractures-minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace:study protocol for a randomised controlled trial. Trials, 2013, 14:246.
3.	Wójcik K, Nowak R, Polak D, et al. Locked intramedullary nailing in the treatment of non-union following humeral shaft fractures. Cases study. Ortop Traumatol Rehabil, 2012, 14(3):279-288.
4.	An Z, Zeng B, He X, et al. Plating osteosynthesis of mid-distal humeral shaft fractures:minimally invasive versus conventional open reduction technique. Int Orthop, 2010, 34(1):131-135.
5.	Lee HJ, Oh CW, Oh JK, et al. Minimally invasive plate osteosynthesis for humeral shaft fracture:a reproducible technique with the assistance of an external fixator. Arch Orthop Trauma Surg, 2013, 133(5):649-657.
6.	Shin SJ, Sohn HS, Do NH. Minimally invasive plate osteosynthesis of humeral shaft fractures:a technique to aid fracture reduction and minimize complications. J Orthop Trauma, 2012, 26(10):585-589.
7.	Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures:are results reproducible? Int Orthop, 2010, 34(8):1297-1305.
8.	Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl):S1-133.
9.	Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? Acadaveric study and preliminary report. Injury, 2005, 36(4):530-538.
10.	Rancan M, Dietrich M, Lamdark T, et al. Minimal invasive long PHILOS^®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury, 2010, 41(12):1277-1283.
11.	Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res, 1981, (155):7-20.
12.	Morrey BF, An KN, Chao EY. Functional evaluation of the elbow//Morrey BF. The elbow and its disorders. 2nd ed. Philadelphia:W. B. Saunders, 1993:86-97.
13.	Lim KE, Yap CK, Ong SC, et al. Plate osteosynthesis of the humerus shaft fracture and its association with radial nerve injury-a retrospective study in Melaka General Hospital. Med J Malaysia, 2001, 56 Suppl C:8-12.
14.	Paris H, Tropiano P, Clouet D'orval B, et al. Fractures of the shaft of the humerus:systemic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot, 2000, 86(4):346-359.
15.	Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation:intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3):162-166.
16.	Oh CW, Byun YS, Oh JK, et al. Plating of humeral shaft fractures:comparison of standard conventional plating versus minimally invasive plating. Orthop Traumatol Surg Res, 2012, 98(1):54-60.
17.	安智全, 何小健, 曾炳芳. 闭合复位微创钢板与切开复位钢板内固定治疗肱骨干中下段骨折的比较研究. 中国修复重建外科杂志, 2009, 23(1):41-44.
18.	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(4):212-216.
19.	Ji F, Tong D, Tang H, et al. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop, 2009, 33(2):543-547.
20.	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. Injury, 2010, 41(2):169-172.

1. Volgas DA, Stannard JP, Alonso JE. Nonunions of the humerus. Clin Orthop Relat Res, 2004, (419):46-50.
2. Matsunaga FT, Tamaoki MJ, Matsumoto MH, et al. Treatment of the humeral shaft fractures-minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace:study protocol for a randomised controlled trial. Trials, 2013, 14:246.
3. Wójcik K, Nowak R, Polak D, et al. Locked intramedullary nailing in the treatment of non-union following humeral shaft fractures. Cases study. Ortop Traumatol Rehabil, 2012, 14(3):279-288.
4. An Z, Zeng B, He X, et al. Plating osteosynthesis of mid-distal humeral shaft fractures:minimally invasive versus conventional open reduction technique. Int Orthop, 2010, 34(1):131-135.
5. Lee HJ, Oh CW, Oh JK, et al. Minimally invasive plate osteosynthesis for humeral shaft fracture:a reproducible technique with the assistance of an external fixator. Arch Orthop Trauma Surg, 2013, 133(5):649-657.
6. Shin SJ, Sohn HS, Do NH. Minimally invasive plate osteosynthesis of humeral shaft fractures:a technique to aid fracture reduction and minimize complications. J Orthop Trauma, 2012, 26(10):585-589.
7. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures:are results reproducible? Int Orthop, 2010, 34(8):1297-1305.
8. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium-2007:Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(10 Suppl):S1-133.
9. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? Acadaveric study and preliminary report. Injury, 2005, 36(4):530-538.
10. Rancan M, Dietrich M, Lamdark T, et al. Minimal invasive long PHILOS^®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury, 2010, 41(12):1277-1283.
11. Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res, 1981, (155):7-20.
12. Morrey BF, An KN, Chao EY. Functional evaluation of the elbow//Morrey BF. The elbow and its disorders. 2nd ed. Philadelphia:W. B. Saunders, 1993:86-97.
13. Lim KE, Yap CK, Ong SC, et al. Plate osteosynthesis of the humerus shaft fracture and its association with radial nerve injury-a retrospective study in Melaka General Hospital. Med J Malaysia, 2001, 56 Suppl C:8-12.
14. Paris H, Tropiano P, Clouet D'orval B, et al. Fractures of the shaft of the humerus:systemic plate fixation. Anatomic and functional results in 156 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot, 2000, 86(4):346-359.
15. Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation:intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3):162-166.
16. Oh CW, Byun YS, Oh JK, et al. Plating of humeral shaft fractures:comparison of standard conventional plating versus minimally invasive plating. Orthop Traumatol Surg Res, 2012, 98(1):54-60.
17. 安智全, 何小健, 曾炳芳. 闭合复位微创钢板与切开复位钢板内固定治疗肱骨干中下段骨折的比较研究. 中国修复重建外科杂志, 2009, 23(1):41-44.
18. 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(4):212-216.
19. Ji F, Tong D, Tang H, et al. Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop, 2009, 33(2):543-547.
20. 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. Injury, 2010, 41(2):169-172.

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COMPARISON OF EFFECTIVENESS BETWEEN ANTERIOR AND LATERAL APPROACHES OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS IN TREATMENT OF HUMERAL SHAFT FRACTURES

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