THE ADVANTAGES OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) BY ANTERIOR APPROACH IN DISTAL HUMERAL SHAFT FRACTURES

Abstract

Introduction: The treatment of complex distal humeral shaft fractures is a challenge due to the fact that intramedullary nails do not present reliable results, while the ORIF with plates is associated with a higher morbidity. The purpose of this study is to exhibit the advantages of MIPO by anterior approach in distal humeral shaft fractures.

Material and methods: 6 fractures in 6 patients (with arm wrestling mechanism in 3 cases) were operated by indirect reduction and biological plating, avoiding the problems related to the neural vascular structures of the arm and especially to the radial nerve. According to AO classification, there were 1 fracture type 12A, 2 type 12B and 3 type 12C. The proximal approach of 3–5 cm was realized between the biceps (medially) and deltoid muscle (laterally). The distal approach of 3–5 cm was performed by subperiosteal dissection of the lateral supracondylar ridge of the humerus, with retraction of brachioradialis and long carpal extensor muscle, as well as the radial nerve, even though unseen. A DCP plate of 4,5 mm with 10–12 holes was molded and twisted medially to adapt to the anterior face of the humeral lateral column and diaphysis, thus avoiding occlusion of the coronoid or of the olecranon fossae. The plate was inserted from distal to proximal and fixed onto the shaft with at least 2 proximal and 2 distal screws, after reestablishing the humeral axis, length and rotation. After a short immobilization (1–2 weeks), the patient started rehabilitation.

Results: There were no vascular or nerve complications except a transient paresthesia for the radial nerve. All fractures healed within a mean time of 10 weeks after surgery, with good functional results regarding elbow mobility.

Discussions: The radial nerve may be endangered in the lateral column approach but even in such circumstances its identification is not required; the implant remains in the safe zone.

Conclusions: The authors are promoting the advantages of this technique regarding safety and feasibility as well as plate stability which allows a fast rehabilitation. Even if it is a demanding technique, MIPO seems to be the best option for distal third humeral fractures.