Minimally invasive plate osteosynthesis in the treatment of proximal humeral shaft fractures

Abstract

Introduction The treatment for proximal humeral shaft fracture is still controversial, attributed to the multiplicity of treatment options. The aim of this study was to evaluate the results of minimally invasive plate osteosynthesis (MIPO) in the treatment of proximal humeral shaft fractures. Patients and methods Between February 2007 and November 2011, 20 patients with displaced fracture of the proximal one-third shaft of the humerus were treated using the MIPO technique. The average age of the patients was 45.3 years, and there were 13 male and seven female patients. Eleven (55%) patients had AO (AO Foundation is a medically guided, not-for-profit organization led by an international group of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system) type 12C fractures. The right humerus was fractured in 11 (55%) patients. Falls were the most common cause of fracture in eight (40%) patients. Follow-up was carried out regularly with radiography and measurement of range of movement of the elbow. Results All fractures healed in an average time of 10.35 weeks within an average follow-up of 23.46 months. Surgery was performed on average 1.75 days after injury. Fractures were fixed using dynamic compression plating in 12 cases and locked plating in eight cases. The average range of elbow range of motion was 123 degrees; 12 (60%) patients were able to achieve full elbow extension at last follow-up. The average extension lag was 5.25°. The average range of elbow flexion was 128.25°. Six complications occurred in our cases. There were two cases of shoulder impingement. One patient developed deep infection. Three (15%) patients had postoperative radial nerve injuries. All of them recovered spontaneously. Conclusion Although MIPO is technically demanding, it is a safe and efficient procedure for the treatment of humeral shaft fracture. Adequate healing and low complication rate can be obtained if the appropriate surgical technique is used. Elbow flexion contracture can be regarded as a possible complication that can be avoided by the use of early adequate elbow rehabilitation protocol.