Percutaneous locking plate osteosynthesis for fracture of surgical neck of humerus: an anatomical and clinical report

Abstract

Objective To explore the feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPO) for humeral surgical neck fractures.Methods In 8 cadaveric specimens of adult upper limbs, a 4 cm transverse incision was made about 2 cm subacromially along the muscle fibers to dissect the muscle layers.A percutaneous locking plate was inserted along the submuscular tunnel and close to the bone surface before it was fixated at both ends with screws.The distances between the axillary nerve and the bony signs of the shoulder, as well as the distances between the axillary nerve and the lateral edges of the plate, were measured.From March 2009 to September 2010, the percutaneous locking plate was used to treat 18 cases of humeral surgical neck fractures after closed reduction.They were 6 men and 12 women, aged from 47 to 86 years (average, 67.4 years).Operation time, blood loss, postoperative hospital stay, postoperative complications, fracture healing time, and ranges of motion of the shoulder and the elbow were documented.Results The distances between the axillary nerve and the acromion, the humeral head and the lower edge of the humeral anatomical neck were respectively 69.09 + 6.07, 55.54 +4.64 and 16.23 +2.91 mm.The 18 patients were followed up for 8 to 16 months (average, 12.6 months).On average, the operative time was 106 + 36 min, intraoperative blood loss 82 + 38 mL, and postoperative hospital stay 6 + 2 days.All fractures healed without wound infection.The average healing time was 16.3 weeks (from 14 to 36 weeks) .No iatrogenic injury to the axillary nerve occurred. Conclusion MIPO is a fine treatment for humeral surgical neck fractures. Key words: Humeral fractures; Fracture fixation, internal; Dissection