The Application of Bidirectional Rapid Reductor in Minimally Invasive Plate Osteosynthesis for the Treatment of Proximal Humeral Fractures: A Case Series

Abstract

Objective: Rapid and effective reduction is difficult for minimally invasive plate osteosynthesis (MIPO) surgery. This study aims to introduce a bidirectional rapid reductor (BRR) designed to assist in the reduction during MIPO surgery for proximal humeral fractures (PHFs).

Methods: This retrospective study was conducted between June 2021 and February 2022 in the Third Hospital of Hebei Medical University, involving patients diagnosed with PHFs. A detailed technical approach of BRR in MIPO surgery was described, and the patients’ outcomes based on postoperative radiographic results including x-ray postoperative follow-up, and clinical outcome parameters including visual analogue scale (VAS) and constant-Murley score at last follow-up were reported.

Results: A total of 12 patients were included in this study, comprising three males and nine females, with an average age of 67.58 years. The mean operative time was 70.92 min (range 63–80 min). The mean blood loss was 102.27 mL (range 50–300 mL). The mean VAS and constant-Murley scores at final follow-up were 0.33 and 88, respectively. All patients had their fractures healed without secondary displacement at last follow-up. One patient experienced shoulder stiffness post-operation. There were no adverse events or complications following the use of this technique, such as acromion fracture, nerve or blood vessel injury.

Conclusion: The BRR can assist MIPO for good reduction of PHFs. However, the efficacy should be validated with a large-sample randomized controlled trial and longer follow-up.

Keywords

Bidirectional rapid reductor / Minimally invasive surgical procedures / Shoulder fractures

References

[1] Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006; 37(8): 691–697.

[2] Stirma GA, Secundino AR, Gonzalez G, et al. Inter/intra-observer evaluation between radiographs and tomographies for proximal humerus fracture. Acta Ortop Bras. 2020; 28(1): 36–39.

[3] Burke NG, Kennedy J, Cousins G, Fitzpatrick D, Mullett H. Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg-Hong K. 2014; 22(2): 190–194.

[4] Li F, Liu X, Wang F, Gu Z, Tao Q, Yao C, et al. Comparison between minimally invasive plate osteosynthesis and open reduction-internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals. BMC Musculoskelet Disord. 2019; 20(1): 550.

[5] Buchmann L, van Lieshout E, Zeelenberg M, et al. Proximal humerus fractures (PHFs): comparison of functional outcome 1 year after minimally invasive plate osteosynthesis (MIPO) versus open reduction internal fixation (ORIF). Eur J Trauma Emerg Surg. 2022; 48(6): 4553–4558.

[6] Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP. Proximal humeral fracture treatment in adults. J Bone Joint Surg Am. 2014; 96(3): 251–261.

[7] Abouelela A, Mubark I, Nagi A, Genena A. Short-term clinical outcome of proximal humeral fracture fixation using minimally invasive trans-deltoid approach. Ortop Traumatol Rehabil. 2020; 22(4): 221–226.

[8] Narayanan VL, Balasubramanian N. Complex proximal humeral fracture fixation with PHILOS plate using minimal invasive percutaneous plate osteosynthesis (MIPPO) technique: a series of 30 patients. Malays Orthop J. 2018; 12(2): 20–24.

[9] Brunner A, Thormann S, Babst R. Minimally invasive percutaneous plating of proximal humeral shaft fractures with the proximal humerus internal locking system (PHILOS). J Shoulder Elbow Surg. 2012; 21(8): 1056–1063.

[10] Oh HK, Cho DY, Choo SK, Park JW, Park KC, Lee JI. Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis. Arch Orthop Traum Surg. 2015; 135(2): 235–242.

[11] Borer J, Schwarz J, Potthast S, Jakob M, Lenzlinger P, Zingg U, et al. Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg S. 2020; 46(4): 825–834.

[12] Beeres F, Quaile OM, Link BC, Babst R. Reduction techniques for minimally invasive stabilization of proximal humeral fractures. Oper Orthop Traumato. 2019; 31(1): 63–80.

[13] Kim YG, Park KH, Kim JW, Oh JK, Yoon JP, Kim HJ, et al. Is minimally invasive plate osteosynthesis superior to open plating for fixation of two-part fracture of the proximal humerus? J Orthop Surg-Hong K. 2019; 27(2): 2309499019836156.

[14] Attala DD, Primavera MM, Di Marcantonio AA, et al. The role of minimally invasive plate osteosynthesis (MIPO) technique for treating 3-and 4-part proximal humerus fractures in the elderly. A case study. Acta Biomed Ateneo Parmense. 2021; 92(4): e2021251.

[15] Chang H, Zheng Z, Yu Y, Shao J, Zhang Y. The use of bidirectional rapid reductor in minimally invasive treatment of bicondylar tibial plateau fractures: preliminary radiographic and clinical results. BMC Musculoskelet Disord. 2018; 19(1): 419.

[16] Lian X, Zhao K, Chen W, Zhang J, Li J, Meng H, et al. Application of a double reverse traction repositor in the retrograde intramedullary nailing of distal femur fractures. J Orthop Surg Res. 2021; 16(1): 168.

[17] Wang Z, Zheng Z, Wang Y, Zhu Y, Tan Z, Chen W, et al. Unilateral locking plate versus unilateral locking plate combined with compression bolt for Schatzker I-IV tibial plateau fractures: a comparative study. Int Orthop. 2022; 46(5): 1133–1143.

[18] Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999; 79(2): 231–252.

[19] Constant CR. Assessment of shoulder function. Orthopade. 1991; 20(5): 289–294.

[20] Liu Y, Wei X, Kuang Y, et al. Open vs. closed reduction combined with minimally invasive plate osteosynthesis in humeral fractures. Minim Invasive Ther Allied Technol. 2016; 25(4): 215–221.

[21] Sohn HS, Jeon YS, Lee J, Shin SJ. Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: a prospective randomized controlled trial. Injury. 2017; 48(6): 1175–1182.

[22] Gavaskar AS, Chowdary N, Abraham S. Complex proximal humerus fractures treated with locked plating utilizing an extended deltoid split approach with a shoulder strap incision. J Orthop Trauma. 2013; 27(2): 73–76.

[23] Li S, Yin Y, Zhang R, Chen W, Zhang Y. Minimally invasive treatment for fractures of lower extremity amputees using a rapid reductor. Int Orthop. 2019; 43(6): 1473–1478.

[24] Chiewchantanakit S, Tangsripong P. Locking plate fixation of proximal humeral fracture: minimally invasive vs. standard delto-pectoral approach. J Med Assoc Thai. 2015; 98(2): 196–200.

[25] Wang JF, Song HB, Gu HJ, Ling ZD, Ma HH. Case-control study on minimally invasive plate osteosynthesis for the treatment of proximal humeurs fractures in elderly patients. Zhongguo Gu Shang. 2012; 25(6): 487–489.

[26] Shen QF, Wen X, Yang SW, Chen X, Fan WX, Xu GZ, et al. MIPPO and ORIF for the treatment of elderly proximal humerus fractures of type Neer II:a case control study. Zhongguo Gu Shang. 2018; 31(2): 160–164.

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.