gms | German Medical Science

Objectives: The incidence of injuries to the proximal humerus is 3-5%.There are rare occasions when a humeral shaft fracture is associated with injury to the proximal humerus. In the few case reports that have been published describing this injury, the proximal humerus fracture is invariably associated with a shoulder dislocation. This association of proximal humerus fracture (with or without dislocation) and ipsilateral humeral shaft fracture should be recognized and probably should be included in future classification systems. This injury requires an early referral to an orthopaedic surgeon for definitive management.The surgical selections of ORIF or MIPPO were allowed for more accurate reduction and better function of the upper extremity for the co-existing fractures of the proximal humerus and humeral shaft. However, there is still a controversy for the surgical techniques of the appropriate treatment of this special type of complex fractures. The purpose of this study is to investigate the therapeutic efficacy between ORIF and MIPPO using the long PHILOS locking compression plate on the co-existing fractures of the proximal humerus and humeral shaft.

Methods: This was an IRB-approved and retrospective study conducted at a single academic Level I institution. Study participation required a non-pathological, co-existed proximal humerus and humeral shaft fractures requiring ORIF or MIPPO techniques. Of 59 patients met these criteria from January 2011 to June 2016, 36 patients were matched to ORIF and 23 patients were matched to MIPPO. All cases were fixed with the long PHILOS locking compression plate. The two groups were matched for age, gender, injury mechanism and reduction technique. Aspects of the treatment courses and surgical treatments of each group were tallied, interpreted, and analyzed for statistical significance. P value was set at <0.05.

Results: There was no significance between the 2 groups with respect to length of surgery, hospital admission time, total treatment time, radial nerve palsy, fracture healing time or range of motion. However, there was significant difference with respect to intraoperative blood loss and transfusion, referral to pain management and functional recovery time. Technically, MIPPO group had better surgical treatment and clinical effects than ORIF group.

Conclusion: This study demonstrates the clinical efficacy of MIPPO techniques for the co-existing fractures of the proximal humerus and humeral shaft is significantly difference from ORIF in some respects. However, there are still some disadvantages of MIPPO technique, such as, major technological hurdles, high requirements for surgeon, long learning curve and high radiation exposure. In conclusion, both of ORIF and MIPPO can be used for the surgical treatment of the co-existing fractures of the proximal humerus and humeral shaft. Nevertheless, MIPPO technique is a better option obviously if you have rich surgical experiences.