Antero-lateral minimally invasive plate osteosynthesis (MIPO) with the radial nerve exploration for extra-articular distal-third diaphyseal fractures of the humerus

Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012–2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats’ ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.

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Secondary Radial Nerve Palsy after Minimally Invasive Plate Osteosynthesis of a Distal Humeral Shaft Fracture

Case Reports in Orthopedics ◽

10.1155/2015/241968 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Ursina Bichsel ◽

Richard Walter Nyffeler

Keyword(s):

Minimally Invasive ◽

Radial Nerve ◽

Nerve Palsy ◽

Plate Osteosynthesis ◽

Shaft Fracture ◽

Humeral Shaft Fracture ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Minimally Invasive Plate Osteosynthesis ◽

Short Time

Minimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation. We report the case of secondary radial nerve palsy caused by percutaneous fixation of a plate above the antecubital fold. The nerve did not recover and the patient needed a tendon transfer to regain active extension of the fingers. This case points to the importance of adequate exposure of the bone and plate if a humeral shaft fracture extends far distally.

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Minimally Invasive Plate Osteosynthesis in Humeral Shaft Fractures via Anterior Approach

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/146 ◽

2021 ◽

Vol 8 (13) ◽

pp. 745-750

Author(s):

Nikhilkumar Sureshkumar Oza ◽

Ganesh A ◽

Anand Kumar Singh ◽

Pulin Bihari Das ◽

Anurag Singh ◽

...

Keyword(s):

Minimally Invasive ◽

Scoring System ◽

Radial Nerve ◽

Anterior Approach ◽

Plate Osteosynthesis ◽

Case Series ◽

Minimally Invasive Plate Osteosynthesis ◽

Fracture Union ◽

Excellent Outcome ◽

Radial Nerve Injury

BACKGROUND This case series was conducted to evaluate the intraoperative and post-operative outcomes of fracture shaft of humerus managed by indirect reduction and minimally invasive plate osteosynthesis (MIPO) via anterior approach. METHODS In this case series 26 diaphyseal fractures of the humerus treated with MIPO, between June 2017 and February 2020 at a tertiary care hospital were included. All the patients were followed up for a minimum period of 2 years postoperatively. The objective was to evaluate these cases clinically for shoulder and elbow range of motion and document any complications. Other parameters such as duration of surgery and radiological time for fracture union were also documented. RESULTS The mean duration for surgery was 86.5 minutes. The University of California Los Angeles (UCLA) shoulder scoring system rated 18 patients (69.2 %) as excellent outcome, 07 patients (26.9 %) as good outcome, and 1 patient (3.8 %) as fair outcome. The MAYO Elbow Performance Scoring system rated 20 patients (76.9 %) as excellent outcome and 06 patients (23.1 %) as good outcome. About 96 % of patients achieved fracture union by the end of 16 weeks post-operatively (mean 13.4 weeks). No complications related to infection, iatrogenic radial nerve injury or implant failure were noted in the study. 4 cases had varus angulation deformity but did not affect shoulder or elbow function. CONCLUSIONS MIPO is a safe and effective technique for the management of diaphyseal humerus fractures, with early fracture healing, less risk of complications such as infection and iatrogenic radial nerve injury, along with a cosmetically acceptable scar. KEYWORDS Fracture Fixation, Fracture Healing, Humeral Fractures, Radial Nerve, Shoulder

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Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures

Injury ◽

10.1016/s0020-1383(17)30487-4 ◽

2017 ◽

Vol 48 ◽

pp. S8-S13 ◽

Cited By ~ 12

Author(s):

Vidisha Sunil Kulkarni ◽

Madhura Sujay Kulkarni ◽

Govind Shivram Kulkarni ◽

Vaibhav Goyal ◽

Milind Govind Kulkarni

Keyword(s):

Minimally Invasive ◽

Intramedullary Nailing ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Minimally Invasive Plate Osteosynthesis ◽

Diaphyseal Fractures

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Anterior humeral approach with nerve stimulator

Journal of Orthopaedic Surgery ◽

10.1177/2309499018803002 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901880300

Author(s):

Murat Gulcek ◽

Mehmet Gamli

Keyword(s):

Minimally Invasive ◽

Nerve Injury ◽

Radial Nerve ◽

Anterior Approach ◽

Screw Fixation ◽

Plate Osteosynthesis ◽

Minimally Invasive Plate Osteosynthesis ◽

Nerve Stimulator ◽

Invasive Approach ◽

Radial Nerve Injury

Introduction: The prevalence of radial nerve injury during surgery is as high as the prevalence of radial nerve injury due to trauma. The aim of this study is to minimize the risk of iatrogenic injury of radial nerve. Materials and Methods: Fifty patients with middle or distal diaphysis fractures of humerus and 18 patients with pseudoarthrosis at the same localizations were treated with surgery. Plate-screw fixation was performed with anterior approach in 43 patients. Eleven patients had minimally invasive plate osteosynthesis, and 14 patients had intramedullary nailing. The localization of the radial nerve was determined with nerve stimulator at the area of dissection. Results: Iatrogenic radial nerve injury did not occur in patients treated with open reduction or minimally invasive approach. Discussion: Nerve stimulator may be a method that decreases radial nerve injury, an iatrogenic complication. This method may be used in anterior approach and minimally invasive procedures.

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