Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures
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ORIGINAL PAPER
Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humeral shaft fractures Ali Hassan Chamseddine 1 & Oussama M. El-Hajj 1 & Ibrahim M. Haidar 1 & Mohammad Jawad H. Rahal 1 & Hussein S. Farhat 1 & Ali A. Hellani 1 & Ali H. Asfour 1 & Mariam M. Zeyneddin 1 Received: 15 May 2020 / Accepted: 15 October 2020 # SICOT aisbl 2020
Abstract Purpose The objective of this study was to evaluate the feasibility and safety of a minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure for proximal humeral shaft fractures using lateral minimal proximal and distal approaches and lateral bridge plating with primary radial nerve control, and to assess its clinical and radiographic outcomes. Methods A retrospective review was done for the medical records of adult patients admitted for fracture of the proximal humeral shaft without associated injury to the ipsilateral upper limb and who consented to undergo a novel MIPPO technique herein reported. Patients were reviewed at regular follow-up periods and assessed at a final follow-up for evaluation of Constant, normalized Constant, and QuickDASH scores. Results There were 21 adult patients with mean age of 56 years. Three patients were lost from early follow-up; one of them had post-operative radial nerve paralysis. Eighteen patients were reviewed for the purpose of this study at a mean of 20 months of final follow-up; among them, one patient developed post-operative radial nerve paralysis with complete recovery after three months. Bone healing was achieved without any malalignment in 17 patients at a mean of 15 weeks, and one patient developed nonunion. At final assessment (mean, 20 months), the mean values of Constant, normalized Constant, and QuickDASH scores were 84 (range, 59 to 100), 95 (range, 73 to 100), and 5 (range, 0 to 18.2) respectively. Conclusion Compared to pre-reported methods of MIPPO, this technique of lateral proximal and distal mini-approaches with lateral bridge plating after primary control of the radial nerve seems safe and feasible for proximal humeral shaft fractures. It gives good clinical and radiographic results with excellent restoration of upper limb function, very low incidence of post-operative radial nerve injury, and high rate of bone union in good alignment. Keywords Humeral shaft fractures . MIPPO for humeral shaft fractures . Percutaneous plate fixation of humeral shaft fractures . Bridge plating of humeral shaft fractures . Biological plating of humeral shaft fractures
Introduction Minimally invasive percutaneous plate osteosynthesis (MIPPO) was initially proposed for treatment of complex diaphyseal and metaphyseal fractures of the lower limbs [1, 2]. MIPPO for humeral shaft fractures has recently been advocated, principally through anterior proximal and distal approaches with anterior placement
* Ali Hassan Chamseddine [email protected] 1
Division of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, PO Box: 99/25, Airport Road, Ghoubeiry, Beirut, Le
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