Functional outcomes of minimal invasive percutaneous plate osteosynthesis (MIPPO) in humerus shaft fractures: a clinical study

Year 2014, , 406 - 412, 03.09.2014

Gazi Huri Omer Sunar Bicer Hakan Ozturk Mehmet Ali Deveci Ismet Tan

https://doi.org/10.3944/AOTT.2014.13.0009

Abstract

Objective: We aimed to evaluate the objective and subjective outcomes of humerus shaft fractures treated with minimal invasive percutaneous plate osteosynthesis and emphasize points which may enhance clinical outcomes and simplify the procedure.

Methods: The retrospective study included 14 patients (mean age: 41.7 years; range: 19 to 66 years) with humerus mid-shaft fractures treated with the MIPPO technique between 2009 and 2011. 4.5-mm locking plates were applied via an anterior approach and advanced antegradely (proximal to distal) to protect the integrity of the deltoid insertion. Fracture healing was evaluated using plain radiographs. Objective outcomes were assessed in terms of range of motion and subjective outcomes using the American Shoulder and Elbow Society (ASES), University of California, Los Angles (UCLA), Mayo Elbow Performance Index (MEPI) and The Disability of The Arm, Shoulder and Hand (DASH) scores.

Results: Satisfactory outcomes with successful union were obtained within a mean of 17.8 (range: 13 to 30) months. While the average active forward flexion of shoulder was 163.9°±5.6°, the mean abduction was 87.8°±3.77°. Mean elbow flexion and extension loss was 134.6°±41.16° and 3.9°±6.25°, respectively. Mean ASES and UCLA scores were 90.2±4.76 and 31.8±1.56 and mean MEPI and DASH score were 93.6±4.12 and 4.6±2.19, respectively.

Conclusion: Minimal invasive percutaneous plate osteosynthesis appears to be a successful technique for the treatment of humerus shaft fractures. The procedure may be simplified and outcomes improved by engaging the plate with the anterior surface of the humerus during advancement, antegrade advancement of the plate to protect deltoid insertion and using of a minimum of 6 cortices for each side of the fracture to provide stable fixation.

Keywords

Fracture, humerus shaft, MIPPO

Humerus şaft kırıklarında minimal invaziv perkütan plak osteosentezinin (MIPPO) fonksiyonel sonuçları: Klinik çalışma

Abstract

Amaç: Çalışmamızda minimal invaziv perkütan plak osteosentezi (MİPPO) ile tedavi edilmiş humerus şaft kırıklarında hem objektif hem de sübjektif sonuçların tartışılmasını ve klinik sonuçları iyileştirecek ve prosedürü kolaylaştıracak noktaların tartışılmasını amaçladık.

Çalışma planı: Bu retrospektif çalışmaya 2009-2011 yılları arasında MİPPO tekniği ile tedavi edilmiş 14 humerus orta şaft kırığı dahil edildi. Hastaların ortalama yaşı 41.7 (dağılım: 19-66) idi. 4.5 mm’lik kilitli plaklar anterior yaklaşım ile deltoid yapışma yerinin bütünlüğünü korumak için antegrad olarak (proksimalden distale) ilerletilerek uygulandı. Kırık iyileşmesi düz radyografiler ile değerlendirildi. Objektif sonuçlar eklem hareket açıklığı, sübjektif sonuçlar ise ASES, UCLA, MEPI ve DASH skorları ile değerlendirildi.

Bulgular: Başarılı kaynamanın görüldüğü tatmin edici sonuçlar ortalama 17.8 (dağılım: 13-30) ayda elde edildi. Omuzun ortalama aktif öne fleksiyonu 163.9°±5.6° iken, ortalama abdüksiyon 87.8°±3.77° idi. Ortalama dirsek fleksiyonu ve ekstansiyon kaybı, sırasıyla, 134.6°±41.16° ve 3.9°±6.25° idi. Ortalama ASES ve UCLA skorları 90.2±4.76 ve 31.8±1.56 olarak ölçülürken, ortalama MEPI ve DASH skoru 93.6±4.12 ve 4.6±2.19 olarak kaydedildi.

Çıkarımlar: Minimal invaziv perkütan plak osteosentezi humerus şaft kırıklarının tedavisinde başarılı bir tekniktir. Plağın ilerletilmesi sırasında plağın humerus anterior yüzü ile temas halinde olması, deltoid yapışma yerinin korunması için plağın antegrad ilerletilmesi ve kırık hattının her iki tarafında en az altı korteks ile stabil tespitin yapılması prosedürü basitleştirecek ve sonuçları iyileştireceğini düşündüğümüz unsurlardır.

Keywords

Humerus şaft; kırık; MİPPO.

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