Clin Orthop Surg.  2017 Dec;9(4):506-513. 10.4055/cios.2017.9.4.506.

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures

• Ko SH
• Cha JR
• Lee CC
• Joo YT
• Eom KS

• KMID: 2412252
• DOI: http://doi.org/10.4055/cios.2017.9.4.506

Abstract

BACKGROUND
This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures.
METHODS
This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated.
RESULTS
The average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks).
CONCLUSIONS
MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.

Keyword

Humeral fractures; Fracture fixation; Screw compression method; Union period; Complication

MeSH Terms

Adult
Aged
Bone Plates
Bone Screws
Diaphyses/injuries/surgery
Elbow Joint/physiopathology
Female
Fracture Fixation, Internal/instrumentation/*methods
Fracture Healing
Humans
Humeral Fractures/diagnostic imaging/*surgery
Male
Middle Aged
Minimally Invasive Surgical Procedures/adverse effects/*methods
*Open Fracture Reduction/adverse effects
Radiography
Range of Motion, Articular
Retrospective Studies
Rotation
Shoulder Joint/physiopathology
Surgical Wound Infection/etiology
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Minimally invasive plate osteosynthesis using a screw compression method. (A) A proper bone alignment is achieved using two locking screws. (B) Compressive force is obtained at the fracture site using two compression screws. (C) Additional locking screws are inserted. (D) Compression screws are replaced with locking screws.

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  Fig. 2 Preoperative radiographs of a 33-year-old male showing a transverse fracture in the middle portion of the humeral shaft. (A) Anteroposterior view. (B) Lateral view.

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  Fig. 3 Simple radiographs showing satisfactory results in the immediate postoperative period. (A) Anteroposterior view. (B) Lateral view.

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  Fig. 4 Simple radiographs showing radiologic union 5 months postoperatively. (A) Anteroposterior view. (B) Lateral view.

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