Minimally invasive osteosynthesis using helical plate for complex humeral shaft fractures involved proximal metaphysis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGXian , YINDong , LIANGBin , JINXianyue

Department of Orthopeadics, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, 530021, P. R. China;

Corresponding author：

WANGXian, Email: drwxgx@163.com

Keywords：

Helical plate; Humeral diaphysis fracture; Minimal invasion; Internal fixation

DOI：

10.7507/1002-1892.20160164

Video：

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Objective To evaluate the effectiveness of minimally invasive osteosynthesis using the helical plate for complex humeral shaft fractures involved proximal metaphysis, and to explore its feasibility and security. Methods A retrospective analysis was made on the clinical data of 16 patients with complex humeral shaft fractures involved proximal metaphysis who underwent minimally invasive osteosynthesis with the helical plate between December 2009 and May 2015. There were 11 males and 5 females, aged from 18 to 56 years (mean, 34.6 years). The causes of fracture included falling injury in 5 cases, falling injury from height in 3 cases, traffic accident injury in 4 cases, sports injury in 3 cases, and belts twisted injury in 1 case. Accroding to Orthopaedic Trauma Association (OTA) classifications, 6 cases were rated as type 12-C1, 3 cases as type 12-C2, and 7 cases as type 12-C3. The time between injury and operation was 2-13 days (mean, 7.2 days). The operation time, intraoperative blood loss, complications, union time were recorded, the functional outcome of the elbow joint was evaluated by Mayo elbow performance score, and the function of the shoulder was assessed by the University of California at Los Angeles (UCLA) shoulder rating scale. Results The mean operation time was 92 minutes (range, 51-127 minutes), and the mean intraoperative blood loss was 212 mL (range, 100-450 mL). All incisions healed by first intention without neurologic complications or wound infection. All patients were followed up 8-28 months (mean, 16.6 months), and bony union was obtained at 13-36 weeks (mean, 19.2 weeks). No loosening or breakage of internal fixation occurred. The Mayo elbow performance score was 90-100 (mean, 99), and the UCLA shoulder rating scale was 31-35 (mean, 34.6). Conclusion The technique of minimally invasive osteosynthesis using the helical plate is safe and feasible for humeral shaft fracture, especially for complex humeral shaft fractures involved proximal metaphysis, and it has the advantages of minimal invasion and low risk for iatrogenic nerve injury and satisfactory effectiveness.

Citation： WANGXian, YINDong, LIANGBin, JINXianyue. Minimally invasive osteosynthesis using helical plate for complex humeral shaft fractures involved proximal metaphysis. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 799-802. doi: 10.7507/1002-1892.20160164 Copy

1.	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.
2.	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.
3.	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(8): 1357.
4.	Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible. Int Orthop, 2010, 34(8): 1297-1305.
5.	Shin S, Sohn H, Do N. Minimally invasive plate osteosynthesis of humeral shaft fractures: atechnique to aid fracture reduction and minimize complications. J Orthop Trauma, 2012, 6(10): 585-590.
6.	Maresca A, Pascarella R, Bettuzzi C, et al. Multifocal humeral fractures. Injury, 2014, 45(2): 444-447.
7.	Fernández D. The principle of helical implants Unusual ideas worth considering. Injury, 2002, 33Suppl 1: SA1-27.
8.	Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury, 2005, 36(1): 75-80.
9.	Gardner MJ, Griffith MH, Lorich DG. Helical plating of the proximal humerus. Injury, 2005, 36(10): 1197-1200.
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.	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.
12.	Saran N, Bergeron SG, Benoit B, et al. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide. Injury, 2010, 41(10): 1037-1040.
13.	Zhou ZB, Gao YS, Tang MJ, et al. Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach. Int Orthop, 2012, 36(11): 2341-2345.
14.	Tan JC, Kagda FH, Murphy D, et al. Minimally invasive helical plating for shaft of humerus fractures: technique and outcome. Open Orthop J, 2012, 6: 184-188.
15.	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.
16.	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.
17.	Zhiquan A, Bingfang Z, Yeming W, et al. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma, 2007, 21(9): 628-633.
18.	López-Arévalo R, de Llano-Temboury AQ, Serrano-Montilla J, et al. Treatment of diaphysealhumeral fractures with the minimally invasive percutaneous plate (MIPPO) technique: acadaveric study and clinical results. J Orthop Trauma, 2011, 25(5): 294-299.
19.	Apivatthakakula T, Arpornchayanona O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury, 2005, 36(4): 530-538.
20.	Moon J, Kwon H, Biraris S, et al. Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopedics, 2014, 37(3): e237-243.
21.	王贤, 尹东, 梁斌, 等.前外侧微创钢板内固定治疗肱骨干远端骨折.中南大学学报(医学版), 2014, 39(11): 1157-1162.

1. 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.
2. 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.
3. 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(8): 1357.
4. Concha JM, Sandoval A, Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible. Int Orthop, 2010, 34(8): 1297-1305.
5. Shin S, Sohn H, Do N. Minimally invasive plate osteosynthesis of humeral shaft fractures: atechnique to aid fracture reduction and minimize complications. J Orthop Trauma, 2012, 6(10): 585-590.
6. Maresca A, Pascarella R, Bettuzzi C, et al. Multifocal humeral fractures. Injury, 2014, 45(2): 444-447.
7. Fernández D. The principle of helical implants Unusual ideas worth considering. Injury, 2002, 33Suppl 1: SA1-27.
8. Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury, 2005, 36(1): 75-80.
9. Gardner MJ, Griffith MH, Lorich DG. Helical plating of the proximal humerus. Injury, 2005, 36(10): 1197-1200.
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. 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.
12. Saran N, Bergeron SG, Benoit B, et al. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide. Injury, 2010, 41(10): 1037-1040.
13. Zhou ZB, Gao YS, Tang MJ, et al. Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach. Int Orthop, 2012, 36(11): 2341-2345.
14. Tan JC, Kagda FH, Murphy D, et al. Minimally invasive helical plating for shaft of humerus fractures: technique and outcome. Open Orthop J, 2012, 6: 184-188.
15. 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.
16. 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.
17. Zhiquan A, Bingfang Z, Yeming W, et al. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma, 2007, 21(9): 628-633.
18. López-Arévalo R, de Llano-Temboury AQ, Serrano-Montilla J, et al. Treatment of diaphysealhumeral fractures with the minimally invasive percutaneous plate (MIPPO) technique: acadaveric study and clinical results. J Orthop Trauma, 2011, 25(5): 294-299.
19. Apivatthakakula T, Arpornchayanona O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury, 2005, 36(4): 530-538.
20. Moon J, Kwon H, Biraris S, et al. Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopedics, 2014, 37(3): e237-243.
21. 王贤, 尹东, 梁斌, 等.前外侧微创钢板内固定治疗肱骨干远端骨折.中南大学学报(医学版), 2014, 39(11): 1157-1162.

Chinese Journal of Reparative and Reconstructive Surgery

Minimally invasive osteosynthesis using helical plate for complex humeral shaft fractures involved proximal metaphysis

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