Minimally Invasive Plate Osteosynthesis versus Intramedullary Nailing for Fixation of Humeral Shaft Fractures in Adults

Author(s): Mohamed Samir Kassem, Elsayed Morsi, Khaled Loutfy El-Adwar, Bahaa A Motawea

Introduction: The two methods of treatment of humeral shaft fractures, namely minimally invasive plate osteosynthesis (MIPO), and antegrade intramedullary nailing (IMN) are reported as satisfactory procedures.

Objective: To compare the clinical and radiological results of MIPO and IMN techniques in surgical treatment of mid humeral shaft fractures.

Patients and methods: From March 2017 to July 2018, a prospective study on 60 patients with closed unilateral mid- humeral shaft fractures were surgically treated with MIPO or IMN. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes (clinically and radiologically) were recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Complications in both groups have been reported. The follow-up duration ranged from 6 to 12 months with a mean duration of 6.7 months.

Results: For group 1 having MIPO technique, the average operative time was 90.3 min (range 50–110), while mean blood loss was 167 ml (range 120–200). In group II patients (interlocking humeral nail), the average time of operation was 100.1 min (range 65–120), and mean blood loss was 118 ml (range 90–150). The mean Constant-Murley shoulder score was 86.95±15.7 in MIPO group and 88.75±13.7in IMN group. The mean Mayo Elbow Performance score in MIPO and IMN groups was 96.5 ± 5.87 and 95.8 ± 6.77, respectively. Radiologic bony union was achieved in 29 out of 30 patients in MIPO group and in 28 out of 30 in IMN group. All the wounds in both groups healed primarily. There was no iatrogenic radial nerve palsies in both groups. Shoulder impingement was found in 2 patients in IMN group. There was no statistically significant difference between two groups in all indexes mentioned above.

Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.

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