Anterior Bridge Plating with Mini Incision MIPO Technique for Humerus Diaphyseal Fractures
Authors: Jayant Sharma, Avinash Jain, Pooja Gupta Jain, Prashant Upadhyaya
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Introduction: Anterior bridge plating with minimally invasive technique in shaft humeral fractures is reported as an acceptable less traumatic and reproducible procedure by several authors. We have evaluated the clinical, radiological, and functional outcome of such fractures in eleven patients, all of which were managed with dynamic compression plate over an average follow-up period of 22 months. Though open reduction and plating technique of humerus shaft fracture is prevailing, this technique also gives favorable outcome.
Materials and Methods: Eleven patients with humerus shaft fractures were managed by anterior bridge plating using MIPO technique between Jan 2013 and April 2015 were included in this series. All cases were treated with closed reduction and 10-12 hole 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function.
Results: Of the Eleven patients in the study, eight were males and three were females. The mean age was 34.3 years (range 20 to 53 years). Eight out of eleven patients (72.7%) had the dominant side fractured. Mean surgical time in minutes was 79.5 (range: 60–100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 95 seconds (range: 70–160 seconds).The mean fracture union (radiological) time was 13.7 weeks (range: 10–18 weeks). One patient (9.1%) develops infection for which premature plate removal and debridement was done at 5 months and managed then conservatively. However Shoulder function was excellent to good in 9 cases (81.8%) and fair in 1 case (9.1%) on the UCLA score.
Conclusion: This study confirmed a high overall rate of union and excellent functional outcomes. Mini incision anterior bridge technique for fracture shaft humerus gives good functional results and should be considered as an effective, cosmetically advanced surgical option in the treatment of humeral shaft fractures. It is a safe and less time consuming method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.