Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds
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ORIGINAL PAPER
Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds of humeral shaft fractures Yao Wang 1 & Huiwen Chen 1 & Lin Wang 1 & Xiao Chen 1 & Xin Zhi 1,2 & Jin Cui 1 & Liehu Cao 3 Received: 16 May 2020 / Accepted: 3 November 2020 # SICOT aisbl 2020
Abstract Purpose Options for the treatment of proximal- and middle-thirds of humeral shaft fractures include intramedullary interlocking nail (IMN) and minimally invasive plate osteosynthesis (MIPO). However, whether IMN provides better clinical outcomes than MIPO surgical technique still remains unclear. This study was designed to compare clinical outcomes of the IMN with MIPO technique for the treatment of proximal- and middle-thirds of humeral shaft fractures. Method A retrospective cohort analysis of 55 proximal- and middle-thirds of humeral shaft fractures surgically treated using IMN (n = 25) or MIPO (n = 30) from January 2012 to January 2016. Peri-operative and follow-up data (a minimum of 1 year) of the patients (aged from 18 to 56 years) were collected. Operative time, union time, VAS scores, surgery-related complications, and implant removal rate were compared between the two groups in this study. Besides, the functional outcomes were evaluated using the Rating Scale of American Shoulder and Elbow Surgeons’ Form (ASES) and Mayo Elbow Performance Score System (MEPS). Result We found significantly shorter operative time and much less blood loss in IMN group, and lower VAS scores in the IMN group after surgery at first and third months but not at the sixth month. Complication rate was found to be relatively higher in the MIPO group when compared to the IMN group. No significant difference was observed between these two groups regarding ASES and MEPS scores. Three patients in the MIPO group suffered iatrogenic radial nerve injury and recovered after four to five months later. No implant failures occurred in either group. Conclusion Intramedullary interlocking nail seemed to be superior to minimally invasive plate osteosynthesis in the treatment of proximal- and middle-thirds of humeral shaft fractures due to shorter operative time and union time, less early post-operative pain, and fewer complications. The intramedullary interlocking nail could be considered a better surgical option for the management of proximal middle humeral fractures, though it may also depend on the surgeons’ skills and learning curve. Further indepth prospective studies are in great need to verify our conclusion. Keywords Humeral shaft fracture . Intramedullary locking nail . Minimally invasive plate osteosynthesis . Surgical decision
Introduction Yao Wang and Huiwen Chen contributed equally to this work. * Liehu Cao [email protected] 1
Department of Orthopedics Trauma, Shanghai Changhai Hospital, Naval Military Medical University, Yangpu District, Shanghai 200433, China
2
Basic Medical School, Naval Military Medical University, Yangpu District, Shanghai 200433, China
3
Department of Orthopedics, Shanghai Baosh
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