J Korean Orthop Assoc.  2010 Dec;45(6):448-455. 10.4055/jkoa.2010.45.6.448.

Minimally Invasive Plate Osteosynthesis of Proximal, Middle and Distal Humerus Fractures

• Shin SJ
• Sohn HS
• Do NH
• Kang SS
• Baek KY

• KMID: 2185492
• DOI: http://doi.org/10.4055/jkoa.2010.45.6.448

Abstract

PURPOSE
The purpose of this study is to evaluate the clinical and radiological outcomes of proximal, middle and distal third humeral fractures treated with the minimally invasive plate osteosynthesis (MIPO).
MATERIALS AND METHODS
Thirty-one patients with the proximal, middle or distal third humeral fractures underwent MIPO. There were 12 men and 19 women with an average age of 46.7 years. The radiological outcomes of bony union and anatomical reduction were evaluated. The clinical outcomes were assessed by measuring the range of shoulder and elbow motion, UCLA scores, KSS sores and the postoperative complications.
RESULTS
Fracture union was obtained in all patients at an average of 18.4 weeks. According to the UCLA scores, 9 were excellent and 3 were good for the proximal humeral fractures. For the middle and distal third fractures, UCLA scoring system showed excellent results in 15 cases and good results in 4 cases. The average KSS scores of proximal and shaft fracture were 92.5 and 98.6, respectively. Complications developed in 3 patients: one had radial nerve palsy, one had a fracture adjacent to the plate distally, and one had a rotational deformity.
CONCLUSION
MIPO for proximal, middle and distal third humeral fractures provided satisfactory clinical and radiological outcomes considering high union rate and minor complications.

Keyword

humeral fractures; minimally invasive plate osteosynthesis

MeSH Terms

Elbow
Female
Humans
Humeral Fractures
Humerus
Male
Paralysis
Radial Nerve
Shoulder
Shoulder Fractures

Figure

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  Figure 1 The axillary nerve is palpated and protected by index finger while the plate is inserted to the proximal humerus fracture site through the deltoid splitting incision.

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  Figure 2 A K-wire is inserted to the proximal humerus through the plate and reduction is achieved by purchasing the cortical screw to the humeral shaft.

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  Figure 3 A 4.5 mm narrow LCP plate is placed on the anterior aspect of the arm under the C-arm so as to draw two longitudinal lines of 3 cm on proximal and distal portion, respectively.

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  Figure 4 Preoperative AP and lateral radiographs of a 28-year-old male show B2 fracture of humerus shaft, clavicle shaft fracture and scapular body fracture. Postoperative radiographs at 10 months show union of the fracture with good alignment.

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  Figure 5 (A) A 3.5/4.5 mm metaphyseal LCP plate is molded to adapt it to the anterior surface of lateral column of distal humerus which is concave and inclined anteriorly in shape. (B) A 24 year-old female with distal third humeral fracture was treated with minimally invasive procedure. (C) Postoperative radiographs at 6 months showed a union of the fracture.

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