The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

[Osteosynthesis with locking plate and minimally invasive technique for proximal humeral fractures]. / Osteosíntesis con placa bloqueada y técnica de mínima invasión para las fracturas de húmero proximal.

OBJECTIVE: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients outcomes. MATERIAL AND METHODS: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. RESULTS: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. CONCLUSIONS: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.

OBJETIVO: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. MATERIAL Y MÉTODOS: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. RESULTADOS: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. CONCLUSIONES: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.

Osteosíntesis con placa bloqueada y técnica de mínima invasión para las fracturas de húmero proximal / Osteosynthesis with locking plate and minimally invasive technique for proximal humeral fractures

Resumen: Objetivo: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. Material y métodos: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. Resultados: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. Conclusiones: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.

Abstract: Objective: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients' outcomes. Material and methods: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. Results: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. Conclusions: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.