HE NEW METHOD OF MINIMALLY INVASIVE OSTEOSYTHESIS OF HUMERAL SHAFT FRACTURES WITH HELICAL PLATES

Abstract

The purpose of investigation is to approve the new method of minimally invasive plate osteosynthesis in cases of diaphyseal humeral shaft fractures with helical plate.

Materials and methods. During experimental cadaveric part of the study implantation of long helical plate on humerus using minimally invasive technique on 14 fresh cadaveric shoulders was done. plate was inserted from two incisions 3-5 cm long in the upper part of the shoulder on the lateral side and in the lower part on the anterior side. Clinical part of the study included 31 patients with isolated humeral shaft fractures and humeral shaft fractures associated with fractures of proximal humerus and treated by minimally invasive fixation with helical plate.

Results. Cadaveric study included preparation and special measuring and showed that implantation of the helical plate in proposed way gives safe distances between plate and axial, radial, musculocutaneous, median nerves, main humeral vessels and tendon of the long head of the biceps.

Results of the clinical part of the study: radiological evidence of bone healing were observed on the 12 weeks in 10 from 28 cases (36%), on the 18 weeks in 18 from 25 (72%), on the 24 weeks in all 25 cases (100%). On the 24 weeks after surgery results on the DASH scale in average were 13±3,6 (from 3 to 36). Where in good results were in 17 (68%) cases, satisfactory in 8 (32%) cases. On the Constant Shoulder Score at the same time averege results were 80±4,63 (from 60 to 91). Exellent result was in 7 (28%) cases, good in 12 (48%), satisfactory in 5 (20%) cases and bad in one (4%) case with subacromial impidgement after wrong plate positioning. There were no any cases of vascular and neurological complications and nonunions.

Conclusion. Minimally invasive fixation of humeral shaft fractures with helical plates is safe and effective method of surgical treatment with good dynamic of functional rehabilitation and can be recommended for clinical use.

Keywords

minimally invasive plate osteosynthesis / humeral shaft fractures / helical plates for osteosynthesis

References

[1] 1. Апагуни А.э., Арзуманов С.В., Воротников А.А., ульянченко М.И. Анатомо-функциональные исходы оперативного лечения больных с переломами диафи-за плечевой кости. Медицинский вестник Северного Кавказа. 2010;(4):32-35.

[2] 2. Джоджуа А.В. Ретроградный остеосинтез бедренной и плечевой костей. Вестник Национального медико-хирургического центра имени Н.И. Пирогова. 2008;(2): 25-27.

[3] 3. Купкенов Д.э. Способ остеосинтеза сегментарного перелома плечевой кости стержневым аппаратом. Травматология и ортопедия России. 2010;(4):73-77.

[4] 4. Тюляев Н.В., Воронцова Т.Н., Соломин Л.Н., Скоморошко п.В. История развития и современное состояние проблемы лечения травм конечностей методом чрескостного остеосинтеза (обзор литературы). Травматология и ортопедия России. 2011;(2):179-190.

[5] 5. Челноков А.Н., Баженов А.В., Корж О.Е. закрытый ан-теградный интрамедуллярный остеосинтез переломов дистальной трети плечевой кости. Вестник травматологии и ортопедии Урала. 2009;(1):49-53.

[6] 6. Шаповалов В.М., Хоминец В.В. Особенности применения внешнего и последовательного остеосинтеза у раненых с огнестрельными переломами длинных костей. Травматология и ортопедия России. 2010;(1):7-13.

[7] 7. Blum J., Janzing H., Gahr R. et al. clinical performance of a new medullary humeral nail: antegrade versus retrograde insertion. J Orthop Trauma. 2001;15:342-349.

[8] 8. Canale S.T., Beaty J.H. Campbell's Operative Orthopaedics. 12th edition: Elsevier Mosby. 2013. p. 2852-2862.

[9] 9. Castoldi F., Blonna D., Assom M. Simple and complex fractures of the humerus. Springer, Italia; 2015. p. 213-248.

[10] 10. Fernandez Dell'Oca A.A. The principle of helical implants. Unusual ideas worth considering. Case studies. Injury. 2002; 33(1):29-40.

[11] 11 Livani B., Belangero W.D. Bridging plate osteosynthesis of humeral shaft fractures. Injury. 2004; 35:587-595.

[12] 12. Ming Y., Baoguou J., Dianying Zh. CN102551863 (B). Anatomical humerus bridge-type bone fracture plate. https://worldwide-i.espacenet.com/publicationDetails/biblio?FT=D&date=20120711&DB=&locale=en_EP&CC=CN&NR=102551863A&KC=A&ND=4

[13] 13. Rommens P.M., Blum J., Runkel M. Retrograde nailing of humeral shaft fractures. Clin Orthop. 1998;35(1):26-39.

[14] 14. Shin S.J., Sohn H.S., Do N.H. Minimally invasive plate osteosynthesis of humeral shaft fractures: a technique to aid fracture reduction and minimize compli-cations. J Orthop Trauma. 2012;26(10):585-589.

[15] 15. Volgas D.A., Stannard J.P., Alonso J.E. Nonunions of the humerus. Clin Orthop Relat Res. 2004;419(1):46-50.

[16] 16. Zhiquan A., Bingfang Z., Yeming W., Chi Z., Peiyan H. Minimally inva-sive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma. 2007;21(9):628-633.