Clinical efficacy of anterior minimally invasive plate osteosynthesis in the surgical treatment of adult mid-distal humeral diaphyseal fractures
Wang Lijun1, Qian Minglei1, Wu Jian1, Fan Shengli1, Tang Tiansi2
1Department of Orthopedics, Affiliated Changshu Hospital of Nantong University, Changshu 215500, China; 2Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Abstract：Objective This study aimed to explore the clinical outcomes of anterior minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of adult mid-distal humeral diaphyseal fractures. Methods A retrospective cohort study was conducted to analyze 73 patients with adult mid-distal humeral diaphyseal fractures admitted to the Affiliated Changshu Hospital of Nantong University from October 2016 to September 2022. The patients consisted of 42 males and 31 females, aged 18-86 (53.0±20.4) years. They were divided into the MIPO group (n=39) and the anterolateral approach open reduction and internal fixation (ORIF) group (n=34) in accordance with the surgical procedure used. Baseline data, such as gender, age, cause of injury, duration of disease, and fracture AO classification, were compared between the MIPO and ORIF groups. Operative time, scar length, radiation exposure time, intraoperative blood loss, postoperative hospitalization time, bone healing time, and surgical-related complications were recorded and analyzed. The functional status of the shoulder and elbow was evaluated using the American Shoulder and Elbow Surgery (ASES) scoring system at different time points (1 week, 1 month, 3 months, and 1 year after the operation) between the MIPO and ORIF groups. Results All the operations in both groups were successfully performed, and the patients were followed up for 13-48 (29.6±2.3) months. No significant difference was observed in the basic data, such as age, gender, cause of injury, duration of disease, and fracture AO classification between the MIPO and ORIF groups (all P values >0.05). No significant difference was noted in surgical time, radiation exposure time, and bone healing time between the two groups (all P values >0.05). Compared with that in the ORIF group, incision length in the MIPO group was shorter ([8.4±1.1] cm versus [13.8±1.9] cm), intraoperative blood loss was less (138.0 [132.0,167.0] mL versus 248.5 [240.8, 290.3] mL), postoperative hospital stay was shorter (4.0 [3.0, 4.0] days versus 6.0 [5.0, 7.0] days), and the differences were statistically significant (t=-14.37, Z=-7.33, Z=-6.29; all P values <0.05). The ASES scores of the MIPO group were higher than those of the ORIF group at 1 week, 1 month, and 3 months after surgery, and the differences were statistically significant (t=6.50, 4.62, 4.67; all P values <0.05). However, no significant difference in ASES scores was observed between the two groups 1 year after surgery (P >0.05). Three cases experienced numbness on the anterolateral forearm because of an injury to the lateral antebrachial cutaneous nerve. Furthermore, neither infection nor iatrogenic radial nerve palsy was observed in the MIPO group. In the ORIF group, four cases exhibited delayed union and one case suffered from infected nonunion after primary surgical stabilization. All these patients were uneventfully healed with revision surgery of autogenous iliac bone grafting. Seven cases experienced numbness between the thumb and the index finger due to radial nerve injury, and they recovered uneventfully 3 months later. Conclusion The MIPO technique via the anterior approach avoids the need for radial nerve visualization and extensive soft tissue dissection. It contributes to less disruption of the blood supply at the segment level and satisfactory clinical outcome. Therefore, this technique should be considered an attractive alternative for patients who require operative intervention of adult mid-distal humeral diaphyseal fractures.
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2024, Vol. 29 
