Vertical Dual Plating For Distal-third Humeral Shaft Fractures Through Medial Approach Combined With Modified Anterior Minimally Invasive Plate Osteosynthesis(MIPO) Approach

Purpose:To evaluate the efficacy and safety of vertical dual plating for distal-third humeral shaft fractures through medial approach combined with modified anterior minimally invasive plate osteosynthesis(MIPO)approach.Methods:The data of all patients with distal-third humeral shaft fractures treated in our hospital from June 2016 to January 2018 were retrospectively analyzed.According to the surgical treatment program,the patients were divided into the vertical dual plating fixation through medial approach combined with modified anterior minimally invasive plate osteosynthesis group(group A)and the single plate fixation through posterior approach group(group B).Records of two groups patients with basic information,operation time,intraoperative blood loss,hospital stay,fracture healing time,elbow motion,MEP score(Mayo here performance score,MEPs)and wound infection,radial nerve injury,intermal fixation failure,complications such as delayed union of fracture,bone nonunion,it was statistically analyzed by the IBM SPSS Statistics 19.0 Software.Results:The 41 patients were included,the 16 patients(9 male patients and 7 female patients)included in group A had an average age of 38.94 years(range,20-69 years),the 25 patients(14 male patients and 11 female patients)included in group B had an average age of 42.96 years(range,21-78 years).All baseline data were balanced between the two groups(P>0.05).The operative time of group A was 103.25±11.62 min and that of group B was 92.68 ± 12.23 min,with no significant difference between the two groups(P>0.05).Intraoperative blood loss was respectively 317.80±36.60 ml,309.38±50.72 ml in group A and B,with no significant difference between the two groups(P>0.05).The hospitalization time of group A was 12.69±2.68 days,and that of group B was 13.48±2.29 days,with no significant difference between the two groups(P>0.05).The bone healing time was respectively 13.25±2.41 weeks,15.60±3.74 weeks in group A and B,and the bone healing time in group A was significantly lower than that in group B(P<0.05).The elbow range of motion was respectively 122.5°±10.47°,111.2°±15.23° in group A and B,and the elbow range of motion in group A was significantly higher than that in group B(P<0.05).The MEP score of group A was 91.56±4.37,and that of group B was 84.00±5.59,and the MEPs score of group A was significantly higher than that of group B(P<0.05).One case of wound infection occurred in group A;A total of 8 complications occurred in group B,including 1 wound infection,3 radial nerve injuries 1 failure of internal fixation,and 3 delayed healing.The incidence of complications was respectively 6.3%,32%in group A and B,and the difference between group A and B was statistically significant(P<0.05).Conclusion:The treatment methods of vertical dual plating for distal-third humeral shaft fractures through medial approach combined with modified anterior minimally invasive plate osteosynthesis(MIPO)approach has the advantages of high healing rate,favorable functional recovery of elbow joint,less complications and aesthetic and concealed incision,which can be considered as one of the treatment methods for the internal fixation of distal-third humeral shaft fractures.