Clin Orthop Surg.  2014 Jun;6(2):146-152. 10.4055/cios.2014.6.2.146.

Complications and Outcomes of Minimally Invasive Percutaneous Plating for Proximal Humeral Fractures

• Park J
• Jeong SY

• KMID: 1784659
• DOI: http://doi.org/10.4055/cios.2014.6.2.146

Abstract

BACKGROUND
The minimally invasive plate osteosynthesis (MIPO) technique using periarticular locking plates may be a good option for the repair of displaced proximal humeral fractures. However, axillary nerve complications related to this technique may be underestimated. The purpose of this study is to evaluate the outcomes of the minimally invasive plating, focusing on the complications.
METHODS
The records of 21 consecutive patients treated for proximal humerus fractures using the MIPO technique with locking plates were retrospectively reviewed. These patients were treated between March 2009 and March 2011 with a minimum one-year follow-up. The clinical function, complications, and radiological bony union were evaluated.
RESULTS
All of the patients, with one exception, showed at least 90 degrees of flexion and abduction at the shoulder joint six months postoperatively. The average Constant scores at three months, six months, and one year follow-ups were 74.0 (range, 62 to 90), 79.4 (range, 64 to 91), and 82.7 (range, 66 to 92), respectively. All of the patients achieved bony union within the average of 3.2 months (range, 2 to 6 months). There was one case of delayed union, one case of intra-articular screw penetration, and one case of axillary nerve paresis (incomplete injury), which did not completely recover during the one year of follow-up.
CONCLUSIONS
The MIPO technique using periarticular locking plates is a useful option for the treatment of selected cases of displaced proximal humeral fractures. However, nerve complications such as axillary nerve paresis should be considered along with implant-related complications when choosing patients for minimally invasive plating.

Keyword

Humerus; Fracture; Minimally invasive; Locking plate; Axillary nerve

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Bone Plates
Female
Fracture Fixation, Internal/*adverse effects
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures/adverse effects
Peripheral Nerve Injuries/etiology
Retrospective Studies
Shoulder Fractures/*surgery
Young Adult

Figure

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  Fig. 1 (A) Proximal humeral fracture. (B) After internal fixation using minimally invasive plate osteosynthesis, a lateral cortical defect (arrow) near the surgical neck was observed on the immediate postoperative radiograph. (C) However, this defect spontaneously disappeared on a radiograph taken six months postoperatively.

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  Fig. 2 Electromyography and nerve conduction velocity studies (NCS) performed one year postoperatively showed that the amplitude of the injured right (Rt) axillary nerve (A) was almost half of the normal amplitude of the uninjured left (Lt) axillary nerve (B). EP: evoked potential.

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