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.

Aims. In order to limit the amount of both medial and lateral dissection, the MIPO technique was developed for extraarticular fractures of the femur. In this prospective study we have evaluated the outcome of 34 cases of supracondylar or subtrochanteric fractures of the femur treated by MIPO technique via exclusive proximal and distal incisions, using a DCS.

Material and methods. Between July 2000 and March 2003, 34 acute fractures (14 supracondylar and 20 subtrochanteric) in 33 patients were included in this study. The technique consisted of 5 major steps: 1. the insertion of the condylar screw using minimal incision; 2. the selection of DCS-plate by fluoroscopy; 3. the insertion of the DCS-plate beneath the vastus lateralis; 4. an additional minimal proximal or distal incision allows plate positioning and its slipping onto the condylar screw; 5. after the limb axis, length and rotation are confirmed by reliable clinical and radiological techniques, the plate was fixed to the shaft with 3 or 4 screws placed divergently.

Results. All fractures healed within a mean time of 14 weeks (range 8–24 weeks). 1 late implant failure (plate screw breakage) in an extremely cominutive fracture did not required repeat fixation. At follow-up, there were 5 varus-valgus deformities above 5°, 4 leg length discrepancies over 15 mm and 1 malrotation of 20°. According to the Neer score there were 22 excellent, 10 satisfactory and 2 unsatisfactory results.

Discussion. The key to MIPO is the use of 2-part and 2-plane alignment achieved by a DCS inserted in a sub-muscular fashion.

Conclusions. The MIPO technique with proximal and distal incisions minimizes surgical trauma and has the advantages of a faster rate of union, with no need for bone grafting. Care should be taken to ensure adequate axial and rotational alignment.