Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

Qiang Huang,Ming Ming Hou,Kun Zhang,Liang Sun,Qian Wang,Yao Lu,Hong Liang Liu,Teng Ma,Zhi Meng Wang,Zhong Li,Ming Li,Han Zhong Xue

doi:10.1186/s13018-021-02355-z

Abstract

BackgroundThe surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures.MethodsA retrospective analysis was carried out. One hundred sixty-six patients with MDTHS fractures were selected from January 2015 to January 2017 in Xi’an Hong Hui Hospital. According to surgical approaches, patients were divided into AATI (86 cases) and PMA group (80 cases). All patients were treated with open reduction and plate fixation. Operation indexes were compared, including incision length, operation time, and bleeding. Bryan-Morrey score was used to evaluate elbow joint function. Complication incidence was compared, such as incision infection, iatrogenic radial nerve injury, and nonunion.ResultsThe AATI group showed smaller incision length, less bleeding, lower iatrogenic radial nerve injury rate, and better elbow function than that of PMA group (P<0.05).ConclusionsThe middle and distal-third humeral shaft fractures can be successfully cured by both approaches. Compared with the posterior median approach, it has better clinical effects of the anterolateral approach with two incisions, which is worthy of clinical application and promotion.

Highlights

The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures
Whether the anterolateral approach with two incisions is superior to the posterior median approach is still unclear
In approach with two incisions (AATI) group, one patient suffered from iatrogenic radial nerve injury, and recovered spontaneously within half a year

Summary

Introduction

The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures. A middle and distal-third humeral shaft (as shown in Fig. 1) fracture refers to the fracture from supracondylar to middle humerus. It is a common fracture of limb shaft, accounting for 25% of all humeral fractures [1, 2]. The clinical effects were compared between the two surgical approaches.

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Results

Discussion

Conclusion