Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

Year 2022, Volume: 5 Issue: 5, 1225 - 1231, 25.09.2022

Özgür Başal Yigit Erdağ Tuna Pehlivanoğlu Abdulhalim Akar Recep Dinçer Mehmet Aydogan

https://doi.org/10.32322/jhsm.1109367

Abstract

Aim: In order to achieve adequate stability in segmental humerus fractures, the PHILOS fixation with minimal invasive approach comes into use instead of conventional plating. However, according to the AO classification, 12C type segmental humerus fractures treated with minimally an invasive method are prone to complications. The purpose of this prospective study is to compare functional outcomes and complication rates following two different angled helical PHILOS plate fixation.
Material and Method: This multicenter study is a prospective review of cases with a final follow-up outcome. Twenty-two patients with AO 12-C humerus fractures underwent PHILOS fixation with contoured PHILOS plates between January 2016 and June 2019. Patients evaluated in two groups. Group 1 consisted 12 patients who were treated with a 30° helical plate and Group 2 consisted 10 patients who were treated with 70° helical plate. Clinical outcomes were noted according to the Constant-Murley scoring system.
Results: The mean age of patients treated in groups 1 and 2 were 49±15.8 and 50.7±17, respectively. Fractures healed in an average of 13.1±3.9 weeks in Group 1 and 13.8±3.1week in Group 2, respectively. The mean follow-up period of the patients was 18±6.1months in Group 1 and 22±4.2 months in Group 2. Mean Constant-Murley scores at final follow-up were 88±2.7 and 90±2.5 in Groups 1 and 2 respectively (p=.665). Radial nerve neuropraxia was seen in 2 cases in Group 1, and a sensorial injury of the musculocutaneous nerve was seen in 1 patient in Group 2 (p=.365).
Conclusion: Similar union rates and successful clinical results were obtained from both groups. However, this study suggests that the 70° angled helical PHILOS technique could be performed relatively easily in AO 12-C fractures with fewer complication rates. Musculocutaneous nerve affliction can be as functionally destructive as radial nerve affliction.

Keywords

Humerus shaft fracture, radial nerve palsy, minimally invasive plate osteosynthesis, safe zone, pre-contoured plate

Supporting Institution

Not

Project Number

No

Thanks

We thank all our health care professionals for their amazing work during COVID outbreak.

References

• Rancan M, Dietrich M, Lamdark T, Can U, Platz A. Minimal invasive long PHILOS®-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury 2010; 41: 1277–83.
• Arumilli B, Suhm N, Marcel J, Rikli D. Long PHILOS plate fixation in a series of humeral fractures. Eur J Orthop Surg Traumatol 2014; 24: 1383–7.
• Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 2007; 21: 628–33.
• Basal O. Principles of External Fixator Applications. In: Atay T, editor. Orthopaedics and Sports Medicine Guide for Researchers. 1st ed. Derman Medical Publishing; 2015. p. 155–68.
• Maiorov BA, Belen’kii IG, Kochish AI. Comparison analysis of using three methods for humeral shaft fracture osteosynthesis. Genij Ortop 2017; 23: 284–91.
• Wang Q, Xu Y, Wang Y, Zhang S, Chen Y, Wang L. Tips and tricks of long helical PHILOS plating on proximal humeral diaphyseal and metaphyseal fractures using the MIPO technique in elderly patients: A cadaveric study and clinical experience. Int J Clin Exp Med 2017; 10: 6489–95.
• Yörükoğlu AÇ, Demirkan AF, Büker N, Akman A, Ok N. Humeral shaft fractures and radial nerve palsy: early exploration findings 2016;
• Pimple M, Chidambaram R, Mok D. Long Philos Plate Fixation for Complex Humeral Fractures. Shoulder Elb 2010; 2: 255–8.
• Seyfettinoğlu F, Oğur HU, Tuhanioğlu Ü, Çiçek H, Kapukaya A. Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients. Clin Interv Aging 2018; 13: 1003.
• Matsunaga FT, Tamaoki MJS, Matsumoto MH, Netto NA, Faloppa F, Belloti JC. Minimally invasive osteosynthesis with a bridge plate versus a functional brace for humeral shaft fractures: A randomized controlled trial. J Bone Jt Surg - Am Vol 2017; 99: 583–92.
• Mehraj M, Shah I, Mohd J, Rasool S. Early results of bridge plating of humerus diaphyseal fractures by MIPO technique. Ortop Traumatol Rehabil 2019; 21: 117–21.
• Da Silva T, Rummel F, Knop C, Merkle T. Comparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases. Arch Orthop Trauma Surg 2020; 140: 1931–7.
• Moon JG, Kwon HN, Biraris S, Shon WY. Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopedics 2014; 37.
• López-Arévalo R, De Llano-Temboury AQ, Serrano-Montilla J, De Llano-Giménez EQ, Fernández-Medina JM. Treatment of diaphyseal humeral fractures with the minimally invasive percutaneous plate (MIPPO) technique: A cadaveric study and clinical results. J Orthop Trauma 2011; 25: 294–9.
• Wang Q, Hu J, Guan J, Chen Y, Wang L. Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: Benefit of pre-contouring plates on a 3D-printed model-a retrospective study. J Orthop Surg Res 2018; 13
• A. B, S. T, R. B. Minimally invasive plating osteosynthesis of proximal humeral shaft fractures with long PHILOS plates. Oper Orthop Traumatol [Internet] 2012; 24 (4–5): 302–11. Available from: http: //www.embase.com/search/results?subaction=viewrecord &from=export&id=L52224621%5Cn http: //dx.doi.org/10.1007/s00064-012-0176-5%5Cn http: //sfx.library.uu.nl/utrecht?sid=EMBASE&issn=09346694&id=doi: 10.1007/s00064-012-0176-5&atitle=Minimally+invasive+plati
• Tan JCH, Kagda FHY, Murphy D, Thambiah JS, Khong KS. Minimally Invasive Helical Plating for Shaft of Humerus Fractures: Technique and Outcome. Open Orthop J 2012; 6: 184–8.
• Narayanan VL, Balasubramanian N. Complex proximal humeral fracture fixation with PHILOS plate using minimal invasive percutaneous plate osteosynthesis (MIPPO) technique: A series of 30 patients. Malaysian Orthop J 2018; 12: 20–4.
• Touloupakis G, Di Giorgio L, Bibiano L, et al. Exploring the difficulties to improve minimally invasive application with long PHILOS plate in multifocal metadiaphyseal fractures of the proximal humerus: Analysis of intraoperative procedure and clinical outcomes. Acta Biomed 2018; 89: 532–40.
• George Malal JJ, Mayne AIW, Arouri F, et al. Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension. Shoulder Elb 2015; 7: 18–23.
• Zamboni C, Carmo BL, Moraes LVM, Hungria JOS, Mercadante MT, Fucs PMMB. A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension. Injury 2019; 50: 2247–51.
• Maresca A, Pascarella R, Bettuzzi C, et al. Multifocal humeral fractures. Injury 2014; 45: 444–7.
• Yang KH. Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus. Injury 2005; 36: 75–80.
• Frigg R. Development of the locking compression plate. Injury 2003; 34.
• Moon JG, Kwon HN, Biraris S, Shon WY. Minimally invasive plate osteosynthesis using a helical plate for metadiaphyseal complex fractures of the proximal humerus. Orthopedics 2014; 37: 237–43.
• Hu X, Xu S, Lu H, et al. Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: A meta-analysis. J Orthop Surg Res 2016; 11.
• Wei W, Zhuang Y, Zhang K, Lu D gang. [Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures with PHILOS plate]. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30: 2553–5.