Comparison Of MIPO And Intramedullary Nail Fixation In The Treatment Of Humeral Shaft Fractures

Backgrounds:Fractures of the shaft of the humerus account for 1% to 3% of all fractures and approximately 20% of all fractures involving the bone. Historically, the treatment of choice for such fractures has been functional bracing, and studies have found that the fractures heal quickly with an acceptable functional outcome. However, some studies have indicated that the incidence of non-union after non-operative treatment is higher in certain patterns of fracture and that not all patients recover fully after non-operative treatment. Patients who sustain high-energy injuries often benefit from surgical stabilization of the fracture. Surgical stabilization can be accomplished with different implants and techniques; the most common are open reduction with plate fixation or stabilization with intramedullary nails. Both techniques have certain mechanical and anatomical advantages and disadvantages. Plate fixation has the advantages of stable fixation, direct visualization, protection of the radial nerve, and sparing of the adjacent shoulder and elbow joint from injury. Intramedullary nails have the advantage of closed insertion techniques, intact periosteal blood supply, and load-sharing mechanical properties. The optimal approach to operative treatment of humeral shaft fractures remains debatable.Though stabilization using plate osteosynthesis is associated with a low risk of infection, this technique usually requires additional soft-tissue stripping and associated with negative features, including the need for a direct exposure of the fracture site, increased blood loss, a risk of radial nerve injury, and disruption of the periosteal blood supply, that can lead to mechanical failure and nonunion. Closed intramedullary stabilization of a humeral shaft fracture can, in theory, avoid these problems. Recent reports of impaired shoulder and elbow function due to antegrade and retrograde nailing in closed humeral fractures have caused some surgeons to shy away from intramedullary nailing for treating open humeral fractures. The humeral Minimally invasive plate osteosynthesis (MIPO) technique provides an alternative way to treat these fractures. Preliminary experience of treating humeral fractures with the MIPO technique had been reported in several small series. MIPO for humeral shaft fractures, with the advantage of minimal soft tissues compromise, had been reported that MIPO technique is a safe alternative way to classic surgical methods in the treatment of humeral shaft fractures, which had a high union rate with less risk of complications. Stable internal fixation of the humeral shaft by less invasive percutaneous plate insertion using two separate (proximal and distal) incisions, indirect reduction by closed manipulation and fixation to preserve the soft tissue and blood supply at the fracture zone. Early mobilization of the shoulder and elbow to ensure a good functional outcome.Objective:To evaluate the clinical outcomes of the newly MIPO technique and intramedullary nail stabilization technique in treating acute humeral shaft fractures.Methods:Data were collected on 52 acute humeral shaft fractures in 52 consecutive patients treated with MIPO technique and compared with retrospective data on 27 fractures in 25 other patients treated with intramedullary nail. The operation time, amount of blood transfusion, time to union, complications, shoulder joint pain and functional recovery were recorded and compared. Multiple cofactors were analyzed using SPSS 12.0 statistic system.Results:In the MIPO group, the mean operation time was 104.6 minutes; the mean intraoperative blood loss volume was 95.1ml.The mean hospital stay after operation was 6.9 days. All the fractures were united within a mean bone healing time of 12.9 weeks. Therewas no iatrogenic radial nerve palsy and non-union case. The MIPO cases achieved satisfactory shoulder function with a mean Constant score of 90.6 points and elbow function with a mean Mayo score of 91.2 points. In the IMN group, the mean operation time was 97.0 minutes; the mean intraoperative blood loss volume was 88.7 ml. The mean hospital stay after operation was 6.5 days. All the fractures were united within at the mean bone healing time of 13.8 weeks except 4 patients whose fractures were not united at the latest visiting. Apart from this, there were 2 iatrogenic radial nerve palsy taken place in the IMN group after the operations. In the IMN group, one varus malunion occurred, without adverse consequences.The IMN cases achieved the shoulder function with a mean Constant score of 85.6 points and elbow function with a mean Mayo score of 89.3 points. Patients had significantly better time to union, complications,and shoulder joint functional recovery after MIPO than after IMN. Operation time, amount of blood transfusion, and eblow joint function showed no difference between the groups.Conclusion:MIPO technique is an effective method in the treatment of humeral shaft fractures, with the advantages of less operative trauma,quick bone union,more satisfied shoulder and elbow function, no need to deliberately exposure of radial nerve and furthermore less risk to occurrence of iatrogenic radial nerve palsy after surgery.