Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures

Jae-Jung Jeong,Sang-Eun Park,Jong-Hun Ji,Min-Sik Park,Yong-Taek Park,Hwan-Hee Lee

doi:10.1186/s12891-019-2757-z

Abstract

BackgroundOur hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension.MethodsFrom January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up.ResultsAll patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures.ConclusionsIn spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.

Highlights

Invasive plate osteosynthesis (MIPO) of humeral shaft fracture has been developed for the past 10 years and recently become popular treatment for these fractures
Mean follow-up was 16 months. 33 patients had complete bone union and 2 patient who had failed with initial surgery using long philos plate (LPP) achieved complete union with revision surgery using narrow locking compression plate (NLCP) and bone graft
In 4.5 mm NLCP group, postoperative functional scores were improved from University of California at Los Angeles scale (UCLA) score of 26.0, American Shoulder and Elbow Surgeons score (ASES) score of 77.1, and Simple Shoulder Test score (SST) score of 7.4 at postoperative 6 months to UCLA score of 27.4, ASES score of 84.0, and SST score of 7.9 at the last follow up

Summary

Introduction

Invasive plate osteosynthesis (MIPO) of humeral shaft fracture has been developed for the past 10 years and recently become popular treatment for these fractures. In spiral humerus shaft fractures with proximal metaphyseal fracture extension, anatomically contoured bending of rigid NLCP plate to the proximal humerus is hard to make adequate fitted fixation (Fig. 1). It might require longer operation time with inadequate frature reduction. In MIPO technique using a long philos plate (long humeral locking plate), already manufactured anatomical plate can adequately fit for fractured humerus contour It might provided easier reduction and less operation time than NLCP. Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension

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