Locking plate fixation of proximal humeral fracture: minimally invasive vs. standard delto-pectoral approach. Chiewchantanakit Siripong,Tangsripong Piroon Journal of the Medical Association of Thailand = Chotmaihet thangphaet OBJECTIVE:To evaluate the results of surgery of proximal humeral fractures using the MIPO technique and to compare that with the results of surgery using the traditional approach. MATERIAL AND METHOD:All PHILOS-plate osteosynthesis operations for two and three part proximal humeral fractures conducted at Chiang Mai University Hospital between January 2010 and December 2011 were evaluated retrospectively. Operative time, blood loss, mean fracture union time, and rate of axillary nerve injury were recorded for each patient. RESULTS:The records of twenty-eight consecutive osteosynthesis operations were reviewed and the patients were divided into two groups. Group A included 12 patients (4 males, 8 females, mean age 52 years) who were treated by MIPO. Group B included 16 patients (8 males, 8 females, mean age 62 years), who were treated using the conventional approach. The mean operative time in group A was 80 minutes (range 55-185), and in group B 110 minutes (range 90-180) (p = 0.059). The mean blood loss in group A was 87.5 ± 42.0 ml, and in group B was 128.1 ± 65.8 ml (p = 0.073). The mean length of hospital stay in group A was 5.7 ± 1.7 days, and in group B was 8.4 ± 4.3 days (p = 0.091). The mean fracture union time in group A was 12 weeks (range 10-24), and in group B was 20 weeks (range 12-28) (p = 0.002). Axillary nerve injury rates were not different between the two groups. CONCLUSION:Compared to conventional techniques, MIPO offers the advantages of significantly shorter time tounion, less blood loss, shorter operative time, and a shorter hospital stay.

Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study. Wang Ji-Qi,Lin Chui-Cong,Zhao You-Ming,Jiang Bing-Jie,Huang Xiao-Jing BMC musculoskeletal disorders BACKGROUND:With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. However, the optimal method for open reduction and internal fixation (ORIF) remains controversial. METHODS:We performed a retrospective analysis of patients with PHF who underwent locking plate internal fixation at our institution from January 2016 to December 2018. Patients were divided into two groups based on the surgical approach used: an expanded deltoid-split approach group (ORIF group) and minimally invasive deltoid-split approach group (minimally invasive percutaneous plate osteosynthesis, [MIPPO] group). The groups were compared in terms of demographic and perioperative characteristics, and clinical outcomes. RESULTS:A total of 115 cases of PHF were included in our study, of which 64 cases were treated using the minimally invasive deltoid-split approach and 51 using the extended deltoid-split approach. Fluoroscopy was performed significantly less frequently in the ORIF group and the surgical duration was shorter. However, the postoperative visual analogue scale (VAS) pain score and duration of postoperative hospital stay were significantly higher compared to the MIPPO group. Moreover, secondary loss was significantly less extensive in the ORIF group compared to the MIPPO group, while there was no significant group difference in fracture healing time, Constant shoulder score, or complications at the last follow-up visit. CONCLUSIONS:The clinical outcomes associated with both the minimally invasive and extended deltoid-split approaches were satisfactory. The data presented here suggest that the extended deltoid-split approach was superior to the minimally invasive deltoid-split approach in terms of operational time, fluoroscopy, and secondary loss of reduction, while the minimally invasive approach was superior in terms of postoperative pain and hospital stay. Accordingly, neither procedure can be considered definitively superior; the optimal surgical procedure for PHF can only be determined after full consideration of the situation and requirements of the individual patient. 10.1186/s12891-020-03417-9

Percutaneous plate fixation of displaced proximal humerus fractures: Do minimally invasive techniques improve outcomes and reduce complications? Injury OBJECTIVE:The aim of this study was to analyze the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humerus fractures and elucidate if the percutaneous technique reduces the rate of avascular necrosis (AVN) without jeopardizing fracture reduction. MATERIAL AND METHODS:118 patients with a displaced proximal humerus fracture were treated with a polyaxial locking-plate through a standardized percutaneous approach. 73 % were women and mean age was 63 years (18-89) with an average follow-up of 51 months (12-256). There were 32 two-part fractures (27 %), 57 three-part fractures (48 %) and 24 four-part fractures (25 %). Shoulder function at the last follow-up, including ROM and ability to perform daily living activities, was objectively evaluated with an adjusted Constant Score (CS). Subjective patient satisfaction was rated with an Visual Analogic Scale from 0 to 10 and the degree of residual pain with a Verbal Rating Scale (VRS). Radiographic analysis at the most recent follow-up evaluated the presence of AVN, degree of residual medial calcar displacement, and the cervicodiaphiseal angle. RESULTS:Forty patients (34 %) had a complication, 25 of them (21 %) requiring further surgery. ROM at the last follow-up was 131° of elevation (40°-180°), 38° of external rotation (SD: 17.7) and internal rotation to L3. Average adjusted Constant Score was 68 (SD: 17.76). Twenty-one patients (18 %) complained of shoulder pain (14 moderate and 7 severe) and seven were not satisfied. Radiographically, 29 patients (25 %) had varus malunion and 17 patients (14 %) showed some degree of AVN. Patients with varus malunion (CS 64.3 versus 69.8, p = 0.16) and AVN (CS 56.9 versus 70.4, p = 0.005) had lower CS. The presence of a varus malunion was directly related to the degree of initial medial calcar displacement (p = 0.001) and deficient calcar reduction at surgery (p = 0.004). AVN was statistically more prevalent when the medial calcar was inadequately reduced (p = 0.01). CONCLUSIONS:MIPO surgery for proximal humerus fractures through an anterolateral approach does not reduce the rate of mechanical complications or AVN compared with standard ORIF techniques. Moreover, percutaneous plating may preclude adequate medial calcar reduction, leading to humeral head malunion and a worse clinical outcome. 10.1016/j.injury.2023.111042

Comparison between minimally invasive plate osteosynthesis and open reduction-internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals. BMC musculoskeletal disorders BACKGROUND:This meta-analysis aimed to compare the clinical outcomes and complications of minimally invasive plate osteosynthesis (MIPO) and open reduction-internal fixation (ORIF) in patients with proximal humeral fractures. METHODS:We searched PubMed, EMBASE, Ovid, and the Cochrane Library to identify all relevant studies from inception to April 2019. Cochrane Collaboration's Review Manage 5.3 was used for meta-analysis. RESULTS:Sixteen studies involving 1050 patients (464 patients in the MIPO group and 586 patients in the ORIF group) were finally included. According to the meta-analysis, MIPO was superior to ORIF in operation time, blood loss, postoperative pain, fracture union time, and constant score. However, MIPO was associated with more exposure to radiation and axillary nerve injury. No significant differences were found in length of hospital stays and complication except for axillary nerve injury. CONCLUSION:The present evidence indicates that compared to ORIF, MIPO had advantages in functional outcomes, operation time, blood loss, postoperative pain, and fracture union time for the treatment of PHFs. However, the MIPO technique had a higher rate of axillary nerve injury and longer radiation time compared to ORIF. 10.1186/s12891-019-2936-y

Proximal humerus fractures: deltopectoral open reduction and internal fixation vs deltosplit minimally invasive plate osteosynthesis: which surgical approach provides superior results? EFORT open reviews Purpose:To compare the two main surgical approaches to address proximal humerus fractures (PHFs) stratified for Neer fracture types, to demonstrate which approach gives the best result for each fracture type. Methods:A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Cochrane databases up to 4 January 2022. Inclusion criteria were studies comparing open reduction and internal fixation (ORIF) with deltopectoral (DP) approach and minimally invasive plate osteosynthesis (MIPO) with deltosplit (DS) approach of PHFs. Patient's demographic data, fracture type, Constant-Murley Score (CMS), operation time, blood loss, length of hospital stay, complications, fluoroscopy time, and radiological outcomes were extracted. Results were stratified for each type of Neer fracture. Results:Eleven studies (798 patients) were included in the meta-analysis. No functional difference was found in the CMS between the two groups for each type of Neer (P = n.s.): for PHFs Neer II, the mean CMS was 72.5 (s.e. 5.9) points in the ORIF group and 79.6 (s.e. 2.5) points in the MIPO group; for Neer III, 77.8 (s.e. 2.0) in the ORIF and 76.4 (se 3.0) in the MIPO; and for Neer IV, 70.6 (s.e. 2.7) in the ORIF and 60.9 (s.e. 6.3) in the MIPO. The operation time in the MIPO group was significantly lower than in the ORIF group for both Neer II (P = 0.0461) and Neer III (P = 0.0037) fractures. Conclusion:The MIPO with DS approach demonstrated no significant differences in the results to the ORIF with DP approach for the different Neer fractures in terms of functional results, with a similar outcome, especially for the Neer II and III fracture types. The MIPO technique proved to be as safe and effective as the ORIF approach. 10.1530/EOR-22-0110