Minimally Invasive Plate Osteosynthesis (MIPO) in the Humeral Diaphysis Fractures

Česká verzia

Authors: K. Šmejkal ^1,2; T. Dědek ²; I. Žvák ^1,2; J. Trlica ²; P. Lochman ^1,2
Authors place of work: Katedra válečné chirurgie, Fakulta vojenského zdravotnictví UO Hradec Králové, vedoucí katedry: doc. MUDr. L. Klein, CSc. ¹; Chirurgická klinika FN a LF UK Hradec Králové, přednosta kliniky: prof. MUDr. A. Ferko, CSc. ²
Published in the journal: Rozhl. Chir., 2009, roč. 88, č. 10, s. 603-607.
Category: Monothematic special - Original

Summary

Introduction:
Most of the humeral shaft fractures can be successfully treated conservatively. Due to increasing number of multiple and high-energy injuries, necessity of patient’s compliance and restriction of his selfcare is conservative treatment in background. Humeral shaft fractures indicated to operation treatment are mostly solved by closed reposition and internal fixation with intramedullar nail (CRIF) or open reposition and internal fixation (ORIF).

Aim:
The aim is to prove that miniinvasive plate osteosynthesis (MIPO) of the humeral shaft fractures combines advantages of the both currently used methods. In other words, to use a plate osteosynthesis with minimal invasiveness and to exclude unexpected complications of radical operation approach by open reposition and problems related to nailing.

Material and method:
From March 2007 to August 2008 we operated on 20 patients with humeral shaft fractures using MIPO technique. Fractures were classified according to AO-classification: A – 9x, B – 5x, C – 6x. There were monotraumas and multiple injuries, as well.

Results:
The results were evaluated by Constant-Murley test and Liverpool elbow scoring system. The mean value was 92/9.1 points. In 75% of patients we have reached good and excellent results. Complications were observed in 5 patients (20%). All patients have been healed.

Conclusion:
In spite of the limited number of patients in case serie our results are in accordance with current published data. Minimally invasive plate osteosynthesis is in our opinion safe and effective operation method for humeral shaft fractures treatment.

Key words:
humeral shaft fractures – minimally invasive plate osteosynthesis

Zdroje

1. Sarmiento, A., Zagorksi, J. B., Zych, G. A., et al. Functional Bracing for the Treatment of Fractures of the Humeral Diaphysis. J. Bone Joint Surg, vol. 82, 2000, p. 478–486.

2. Bhandari, M., Deveraux, P. J., McKee, M. D., et al. Compression plating versus intramedullary nailing of humeral shaft fractures – a meta analysis. Act. Orthop., vol. 77, 2006, p. 279–284.

3. Chapman, J. R., Heneley, M. B., Agel, J. B., et al. Randomized Prospective Study of Humeral Shaft Fracture Fixation: Intramedullary Nails Versus Plates. J. Orthop. Trauma, vol. 14, 2000, p. 162–166.

4. McCormac, R. G., Brien, D., Buckley, R. E. Fixation of the shaft of the humerus by dynamic compression plate or intramedullary nail. J. Bone Joint Surg, vol. 82, 2000, p. 336–339.

5. Chao, T. Ch., Chou, W. Y., Chung, J. Ch., et al. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int. Orthop., vol. 29, 2005, p. 88–91.

6. Changulani, M., Jain, UK., Keswani, T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomized controlled study. Int, Orthop,, vol. 31, 2007, p. 391–395.

7. Lin, J. Treatment of Humeral Shaft Fractures with Humeral Locked Nail and Comparison with Plate Fixation. J. Trauma, vol. 44, 1998, p. 859–864.

8. Martinez, A. A., Cuenca, J., Herrera, A. Treatment of humeral shaft nonunions: nailing versus plating. Arch. Orthop. Trauma Surg., vol. 124, 2004, p. 92–95.

9. Lin, J., Inoue, N., Valdevit, A., et al. Biomechanical Comparison of Antegrade and Retrograde Nailing of Humeral Shaft Fracture. Clin. Orthop., vol. 351, 1995, p. 203–213.

10. Lin, J., Shen, P. W., Hou, S. M. Complication of Locked Nailing in Humeral Shaft Fractures. J. Trauma, vol. 54, 2003, p. 943–949.

11. Rommens, P. M., Verbruggen, J., Broos, P. L. Retrograde Locked Nailing of Humeral Shaft Fractures. J. Bone Joint Surg, vol. 77, 1995, p. 84–89.

12. Scherlinck, T., Handelberg, F. Functional Outcome after Intramedullary Nailing of Humeral Shaft Fractures: Comparison between Retrograde Marchetti-Vincenzi and Unreamed AO Antegrade Nailing. J. Trauma, vol. 52, 2002, p. 60–71.

13. Peter, R. E., Hoffmeyer, P., Henley, M. B. Treatment of humeral diaphyseal fractures with Hackethal stacked nailing: a report of 33 cases. J. Orthop. Trauma, vol. 6, 1992, p. 14–17.

14. Henley, M. B., Chapman, J. R., Claudi, B. F. Closed retragrade Hackethal nail stabilization of humeral shaft fractures. J. Orthop. Trauma, vol. 6, 1992, p. 18–24.

15. Lau, T. W., Leung, F., Chan, C. F., et al. Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture. Int. Orthop., vol. 31, 2007, p. 657–664.

16. Zhiquan, A., Bingfang, Z., Yeming, W., et al. Minimally Invasive Plating (MIPO) of Middle and Distal Third Humeral Shaft Fractures. J. Orthop. Trauma, vol. 21, 2007, p. 628–633.

17. Jiang, R., Luo, CF., Zeng, B. F., et al. Minimally invasive plating for complex humeral shaft fractures. Arch Orthop. Trauma Surg., vol. 127, 2007, p. 531–535.

18. Zhiquan, A., Bingfang, Z., Xiaojian, H., et al. Plating osteosynthesis of mid - distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int. Orthop., 2009, March 20 (Epub ahead of print).

19. Livani, B., Belangero, W., Anadrade, K., et al. Is MIPO in humeral fractures really safe? Postoperative ultrasonographic evaluation. Int. Orthop., 2008, Aug 13 (Epub ahead of print).

20. Fang, J., Dake, T., Hao, T., et al. Minimally invasive percutaneus plate osteosynthesis (MIPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int. Orthop., vol. 33, 2009, p. 543–547.