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Minimally invasive plate osteosynthesis for humeral shaft nonunion: A report of two cases.

ABSTRACT: Introduction:We treated two cases of humeral shaft nonunion by minimally invasive plate osteosynthesis (MIPO) without autogenous bone grafting. Presntation of case:Case 1: An osteosynthesis with intramedullary nailing (IMN) was performed on a 17-year-old female for a humeral shaft fracture at another hospital; however, bony union was not obtained. We removed the nail and screws, then performed MIPO without autogenous bone grafting. At the final follow-up of 4 years after the surgery, she had obtained full range of motion.Case 2: Osteosynthesis with Rush pins had been performed in a 73-year-old female for a humeral shaft fracture at another hospital. Five months later, a revision surgery using IMN was performed at the same hospital; however, this led to nonunion. We removed the IMN and performed MIPO without autogenous bone grafting. At the final follow-up 2 years after surgery, she had obtained full range of motion. Discussion:The cause of nonunion is the lack of mechanical instability and/or biological activity. In these cases, from the findings of radiography and bone scintigraphy, mechanical instability was thought to be the primary cause; therefore, in order to enhance stability, we used a locking plate. Because we can see that these cases are biologically active, we decided not to use bone grafting. Both our cases successfully achieved bony union and excellent functional recovery using this method. Conclusion:We performed MIPO without exposure of the nonunion site and autogenous bone grafting in two cases of humeral shaft nonunion, and obtained successful clinical outcomes.

SUBMITTER: Suda Y

PROVIDER: S-EPMC6831660 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Minimally invasive plate osteosynthesis for humeral shaft nonunion: A report of two cases.

Suda Yoshihito Y Oe Keisuke K Fukui Tomoaki T Mifune Yutaka Y Inui Atsuyuki A Kawamoto Teruya T Kuroda Ryosuke R Niikura Takahiro T

Annals of medicine and surgery (2012) 20191011

<h4>Introduction</h4>We treated two cases of humeral shaft nonunion by minimally invasive plate osteosynthesis (MIPO) without autogenous bone grafting.<h4>Presntation of case</h4>Case 1: An osteosynthesis with intramedullary nailing (IMN) was performed on a 17-year-old female for a humeral shaft fracture at another hospital; however, bony union was not obtained. We removed the nail and screws, then performed MIPO without autogenous bone grafting. At the final follow-up of 4 years after the surge ...[more]

PMID: 31700621

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Project description:ObjectiveThe treatment of distal third humeral shaft fracture is difficult. Studies have shown that anterior minimally invasive plate has lower probability of complication and higher healing rate. However there is no applicable anatomical plate at present. This study is to investigate the clinical effect of intramedullary nail combined with anterior minimally invasive plate in the treatment of distal humeral shaft fractures.MethodsThe data of 83 patients with lower humerus shaft fracture treated from September 2015 to January 2020 were analyzed. According to different treatment methods, they were divided into two groups: 40 patients were treated with intramedullary nailing combined with minimally invasive anterior plate fixation (group A), and 43 patients were treated with double plate fixation through posterior approach (group B). General preoperative data, operative time, intraoperative blood loss, total incision length, fracture healing time, shoulder and elbow visual analogue scale (VAS) score, Constant-Murley shoulder function score, Mayo elbow function score, and complications were recorded and compared between the two groups. Two independent sample t-tests was used for follow-up, age, BMI, operation time, intraoperative bleeding, total incision length, fracture healing time, Constant-Murley score and Mayo score, and rank sum test was used for VAS score of shoulder and elbow.ResultsThere was no significant difference in preoperative general data between the two groups (p > 0.05), indicating comparability. There were no significant differences in operation time, total incision length, fracture healing time, Constant-Murley shoulder function score at the last follow-up, Mayo elbow function score, and shoulder and elbow VAS pain score between 2 groups (p > 0.05). The amount of intraoperative blood loss in observation group was 76.98 ± 16.46, which was significantly less than that in control group, and the difference was statistically significant (p < 0.01). There were no radial nerve injury, musculocutaneous nerve injury, incision infection and fracture nonunion in the observation group. In the control group, four cases of iatrogenic radial nerve injury, three cases of incision infection and three cases of fracture nonunion were found. The complication rate was 23.3% (10/43). There was statistical difference in the incidence of complications between the two groups (p < 0.01).ConclusionA humeral intramedullary nail combined with an anterior minimally invasive plate in the treatment of distal humeral shaft fracture has the advantages of less soft tissue damage, less blood transfusion, high fracture healing rate and low risk of iatrogenic radial nerve injury, which is an effective method for clinical treatment of this type of fracture.

Project description:BackgroundMany surgical treatment methods exist for clavicle shaft fractures. A locking compression plate (LCP) fixation with three screws per fracture side is commonly used. For certain fractures a stabilization with 2 screws per side is potentially suitable, offering the advantage of reduced soft tissue approach, while avoiding the disadvantages of minimally-invasive nailing at the same time. This hypothesis was evaluated biomechanically and clinically.MethodsFour treatment procedures were investigated biomechanically using composite human clavicle specimens. A load-to-failure test was performed using a three-point cantilever test. In group 1, a simple shaft fracture was simulated and stabilized with 2 screws per fracture side (5-hole LCP). In the second group 3 screws per side (7-hole LCP) were used. In group 3, a non-reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). In group 4, an anatomically reduced fracture zone was simulated and treated with 3 screws per side (7-hole LCP). Furthermore 27 patients treated with a short plate and 2 screws per side (similar to group 1) were assessed after a minimum follow-up of 12 months (Constant and DASH Score).ResultsThe maximum load-to-failure of group 1 was 367N. We observed the highest load-to-failure in group 2 with 497N and the lowest in group 3 with 90N. In group 4 a maximum load-to-failure of 298N could be evaluated. There was no significant difference in load-to-failure between the treatment of a simple clavicle fracture using 5- or 7-hole LCP (p = 0.121). However, we found a significant difference of load-to-failure between the simple and anatomically reduced fracture using a 7-hole plate (p = 0.014). The mean constant score of the surgically treated patients was 95 and the DASH score 3.0. Fracture consolidation was observed in 96.3%.ConclusionsFor certain non-fragmented and well interlocking 2-part fractures, a plate osteosynthesis fixed with only 2 screws per fracture side might offer sufficient biomechanical stability, better soft tissue preservation and comparable fusion rates compared to the operative treatment with 3 screws per side. However, the maximum load-to-failure of the 7-hole LCP was higher than of the 5-hole LCP, but this difference was not statistically significant.Trial registrationApproval from the ethics committee of the Technical University of Dresden was retrospectively obtained (EK 588122019).

Project description:BACKGROUND:Although most humeral nonunions are successfully treated with a single procedure, some humeral nonunions are more difficult to heal and require multiple procedures. Current literature does not provide evidence describing how the prognosis for surgical repair in patients who develop humeral diaphyseal nonunions may be affected by initial operative versus nonoperative treatment. QUESTIONS/PURPOSES:The purpose of this study was to assess whether operative versus nonoperative treatment of acute humeral shaft fractures impacts outcome of subsequent repairs of humeral nonunions (NU) including the need for additional surgery and a comparison of pain relief (Visual Analogue Scale for pain) and functional outcome (Short Musculoskeletal Functional Assessment). METHODS:Thirty-four patients with humeral shaft nonunion were evaluated of which 15 patients had been treated operatively (OF), and 19 patients had been treated nonoperatively (NO) for their initial humerus shaft fracture. All patients underwent plating with autogenous bone graft or allograft ± bone morphogenic protein (BMP) 2 or 7 as their final NU repair surgery prior to healing. We compared functional outcome and pain for both cohorts and determined risk factors for requiring more than 1 nonunion repair surgery. RESULTS:The mean time of final follow-up was 14.7?±?10.4 months. Thirty-three of 34 NUs (97.1%) healed. Patients who underwent OF of their original fracture were more likely to require more than 1 NU repair surgery (66.7 vs. 0%, p?<?0.01). Of the 15 patients who underwent initial OF, 33.0% required 1 NU surgery, 33.0% required 2 NU surgeries, and 33.0% required 3 NU surgeries. Patients who underwent initial OF were more likely to require >6 months to achieve union (40.0 vs. 10.5%, p?=?0.04). At final follow-up, there was no difference in functional outcome or pain scores. Initial OF was the only independent predictor of needing more than 1 NU repair surgery (OR 70.1 CI 2.8-1762.3) to achieve healing. CONCLUSION:Humeral shaft nonunions following initial operative fixation of the index fracture is more resistant to achieving union when compared to nonunions forming after initial nonoperative treatment. When final healing is achieved, there is no difference in function or pain.

Project description:IntroductionThe aim of systematic review and meta-analysis was to find out whether minimally invasive plate osteosynthesis (MIPO) is better than open reduction and internal plate fixation (ORIF) in terms of functional outcome, achieving union (union time and incidence of non-union), intraoperative parameters (surgical duration, blood loss, and radiation exposure), and complications (iatrogenic radial nerve palsy and infection) for humeral shaft fractures.Materials and methodsWe searched online databases (Pubmed, Embase, Scopus, and The Cochrane Library) from inception till 3rd September 2020 for articles comparing MIPO with ORIF for humeral shaft fractures. The methodological quality of randomized controlled trials (RCTs) was done by Cochrane Risk of Bias assessment tool 2 (RoB2) and of non-randomized studies (case-control and cohort studies) by Methodological Index for non-randomized studies (MINORS). Meta-analysis was performed using Review Manager 5.4 software.Results11 studies (5 RCTs and 6 non-randomized comparative studies) involving a total of 582 patients (MIPO-290, ORIF-292) meeting our inclusion criteria were included in the study. There was no statistically significant difference in pooled analysis of functional outcome scores between MIPO and ORIF. Union time was significantly lesser (mean difference = 3.12 weeks) and incidence of non-union lower (odd's ratio = 0.27) in MIPO group. Surgical duration and intraoperative blood loss were significantly lesser in MIPO group. Iatrogenic radial nerve palsy and infection were higher in ORIF group.ConclusionsThis study showed that MIPO gives similar functional outcomes as compared to ORIF but causes significantly lesser blood loss, requires lesser operative duration and has a lesser incidence of major complications.Trial registrationInternational prospective register of systematic reviews (PROSPERO)-CRD42020208346, Date of registration 09/10/2020.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-021-00413-6.

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Minimally invasive plate osteosynthesis for humeral shaft nonunion: A report of two cases.

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Minimally invasive plate osteosynthesis for humeral shaft nonunion: A report of two cases.

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