Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

Abstract Background The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures. Methods A retrospective analysis was carried out. One hundred sixty-six patients with MDTHS fractures were selected from January 2015 to January 2017 in Xi’an Hong Hui Hospital. According to surgical approaches, patients were divided into AATI (86 cases) and PMA group (80 cases). All patients were treated with open reduction and plate fixation. Operation indexes were compared, including incision length, operation time, and bleeding. Bryan-Morrey score was used to evaluate elbow joint function. Complication incidence was compared, such as incision infection, iatrogenic radial nerve injury, and nonunion. Results The AATI group showed smaller incision length, less bleeding, lower iatrogenic radial nerve injury rate, and better elbow function than that of PMA group (P<0.05). Conclusions The middle and distal-third humeral shaft fractures can be successfully cured by both approaches. Compared with the posterior median approach, it has better clinical effects of the anterolateral approach with two incisions, which is worthy of clinical application and promotion.

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Functional outcome of middle third humeral shaft fractures treated with anteromedial plate osteosynthesis through an anterolateral approach

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181795 ◽

2018 ◽

Vol 4 (3) ◽

pp. 436

Author(s):

Sandeep Kubsad ◽

Suresh B. ◽

Bharath S. G. ◽

Manohar Reddy ◽

Harish S. Pai

Keyword(s):

Functional Outcome ◽

Nerve Injury ◽

Functional Assessment ◽

Radial Nerve ◽

Plate Osteosynthesis ◽

Humeral Fractures ◽

Humeral Shaft ◽

Anterolateral Approach ◽

Humeral Shaft Fractures ◽

Radial Nerve Injury

Background: The main aim of treatment of the humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. Plate osteosynthesis remains the standard of surgical treatment displaced middle third humeral fractures. The most commonly used approaches for treating these fractures are posterior and anterolateral, but these approaches can have iatrogenic radial nerve injury. Our aim is to study the incidence of radial nerve palsy and functional outcome of anterolateral approach with anteromedial plating.Methods: A total of 26 patients in the age group of 21 to 62 years were included in this prospective study, who were treated by anteromedial plating through anterolateral approach for humerus shaft. Functional assessment was done using Rodriguez-Merchan criteria.Results: 26 patients with shaft humerus fracture were included in the study with 19 (73%) patients were less than 40 years age. Most common type of fracture pattern is A3 type and the mean duration of surgical time was 60±10 min for anteromedial plating. The time taken for the fracture union was less than 4 months in the most patients (88%). There was no evidence of iatrogenic radial nerve injury. Functional assessment done using Rodriguez-Merchan criteria showed 84.6% of the patients had good to excellent functional outcome.Conclusions: For treatment of displaced middle third humeral fractures open reduction with anteromedial plating through anterolateral approach is surgically safer and gives better functional outcome.

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