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Surgical field of a right shoulder showing the two skin incisions performed for the MIPO technique. The proximal incision starts at the anterolateral corner of the acromion (arrow) and is approximately 5 cm long; the length of the distal incision varies according to the number of diaphyseal screws implanted. The white line shows the level and course of the axillary nerve.
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Background
The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site.
Materials and Methods
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Citations
... Kỹ thuật MIPO gãy đầu trên xương cánh tay với nẹp PHILOS đã trở nên phổ biến, các nghiên cứu gần đây như: Gönç U [5], Alberio RL [6], Dario Attala [7] cho thấy MIPO với đường tiếp cận trước ngoài cơ delta là một lựa chọn an toàn và hiệu quả với gãy đầu trên xương cánh tay 3 mảnh. ...
Gãy trật đầu trên xương cánh tay kèm gãy thân xương cánh tay cùng bên là loại hiếm gặp. Y văn ghi nhận chỉ ghi nhận các báo cáo ca lâm sàng và phương pháp điều trị chưa thống nhất. Chúng tôi báo cáo một bệnh nhân nữ 79 tuổi, gãy đầu trên xương cánh tay ba phần, trật khớp vai kèm gãy thân xương cánh tay cùng bên, rách cũ gân trên gai. Bệnh nhân được điều trị kết hợp xương nẹp vít xâm lấn tối thiểu thông qua đường mổ delta – ngực. Sau 33 tháng theo dõi cho kết quả lành xương và phục hồi chức năng tốt. Kết hợp xương nẹp vít xâm lấn tối thiểu là một lựa chọn điều trị an toàn và hiệu quả cho loại gãy xương này, cần cân nhắc nguy cơ hoại tử chỏm trước khi can thiệp.
... however, the MipO technique had a higher rate of axillary nerve injury and longer radiation time than OriF. in many studies, MipO patients had better functional results at 3 and 6 months, with better outcomes, less pain, higher satisfaction in activities of daily living, higher range of motion, and higher cs, dash, and sst when compared to OriF. the results become comparable in one year. 23,[33][34][35][36] these results could be due to shorter surgical time, less adhesion and better soft tissue management. 33 MipO for proximal humeral fractures is an effective and safe surgical procedure. ...
... Nowadays, various types of surgical interventions are performed, in particular: closed reposition and fi xation with needles or cannulated screws, open reposition and osteosynthesis with bone plates, transosseous suture, blocking intramedullary osteosynthesis [1,2,9]. However, despite the variety of surgical techniques, there are a number of unsuccessful treatment outcomes: soft tissue suppuration and postoperative osteomyelitis, post-traumatic osteoarthritis, migration of metal structures, neurological complications, re-displacement of fragments, subacromial dysfunction of a limb [4,6,11]. According to a number of authors [1,5,8], about 50% of unsatisfactory results of treatment of the proximal shoulder with displacement of fragments are associated with repeated unsuccessful attempts at closed repositioning. ...
The aim of the study – evaluation of the surgical treatment effectiveness of fractures inthe proximal metaepiphysis of the humerus, the analysis and generalization of the surgerylong-term results of the surgical intervention.Materials and methods. The study has examined and analyzed the results of surgicaltreatment of the proximal humerus fractures in 76 patients who were treated in thetraumatology department of the regional municipal institution «Chernivtsi EmergencyHospital» in the period from 2015-2020. The average age of patients was 52 years old.The results of treatment were evaluated clinically, radiologically and by questionnaire(according to the QuickDASH scale) for 1 year after osteosynthesis. In order toeliminate the influence of individual, age and gender factors, the results of treatmentof the injured limb were compared with the function of a healthy limb of the patient.The QuickDASH scale (brief scale for assessing the inability to use the upper limb)consists of 11 questions that are offered to the patient. The answer to each questionis rated from 0 (best result) to 5 (worst). Using a special formula, the total result iscalculated, which can range from 0 (no violations) to 100 (complete inability to usethe limb). The QuickDASH scale is a brief version of the DASH scale that retains therepresentativeness of the full version.Results. It has been established that the choice of different methods of surgicalinterventions for fractures of the proximal humerus requires consideration of variousfactors, including the patient’s age, type of fracture, the presence of comorbidities,osteoporosis and the patient’s social needs. It has been shown that the long-termconsequences of surgical interventions may also be due to those factors. A methodfor ensuring stable fixation of fragments, which involves holding the spokes throughthree points: acromion-bone fragment- distal metaepiphysis of the humerus, has beenproposed and described.Conclusions. The tactics of surgical treatment of patients with the proximal humerusfractures depends on many factors, including: type of fracture, age of the patient, thepresence of comorbidities, the presence of osteoporosis and social needs of the patient.Closed reposition under the control of EOA (Electron- optical X-ray image amplifier) andfixation with needles allows to improve the results of treatment and reduce the duration ofdisability. Long-term results of treatment of patients with the proximal humerus fractureshave shown that closed reposition and fixation of fractures with needles leads to bettertreatment results compared to bone osteosynthesis.
... The greater tuberosity of the humerus is the point of attachment of the rotator cuff, which often pulls the fractured fragments apart after avulsion [2,3]. Most greater tuberosity fractures can be treated without surgery, but some have a poor prognosis because of shoulder joint pain, movement limitation, acromion impingement, limb weakness, and other functional disorders [4][5][6]. The main surgical procedures for simple avulsion fractures are screw fixation, suture anchor fixation, and plate fixation [3]. ...
Background:
Most greater tuberosity fractures can be treated without surgery but some have a poor prognosis. The surgical procedures for avulsion fractures of the humeral greater tuberosity include screw fixation, suture anchor fixation, and plate fixation, all of which have treatment-associated complications. To decrease surgical complications, we used a modified suture bridge procedure under direct vision and a minimally invasive small incision to fix fractures of the greater tuberosity of the humerus.
Aim:
To investigate the clinical efficacy and outcomes of minimally invasive modified suture bridge open reduction of greater tuberosity evulsion fractures.
Methods:
Sixteen patients diagnosed between January 2016 and January 2019 with an avulsion-type greater tuberosity fracture of the proximal humerus and treated by minimally invasive open reduction and modified suture bridges with anchors were studied retrospectively. All were followed up by clinical examination and radiographs at 3 and 6 wk, 3, 6 and 12 mo after surgery, and thereafter every 6 mo. Outcomes were assessed preoperatively and postoperatively by a visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeon score (ASES), and range of motion (ROM) for shoulders.
Results:
Seven men and nine women, with an average age of 44.94 years, were evaluated. The time between injury and surgery was 1-2 d, with an average of 1.75 d. The mean operation time was 103.1 ± 7.23 min. All patients achieved bone union within 3 mo after surgery. VAS scores were significantly decreased (P = 0.002), and the mean degrees of forward elevation (P = 0.047), mean degrees of abduction (P = 0.035), ASES score (P = 0.092) were increased at 3 wk. The UCLA score was increased at 6 wk (P = 0.029) after surgery. The average degrees of external rotation and internal rotation both improved at 3 mo after surgery (P = 0.012 and P = 0.007, respectively). No procedure-related deaths or incision-related superficial or deep tissue infections occurred.
Conclusion:
Modified suture bridge was effective for the treatment of greater tuberosity evulsion fractures, was easier to perform, and had fewer implants than other procedures.
... Regarding the rate of necrosis, Boudard and Konrad describe no significant difference between LP and HN patients [12,26]. The rate of humeral head necrosis after LP osteosynthesis varies in several studies, ranging from 0 to 68% [11,13,14,24,26,[39][40][41][42][43][44][45]. Following surgery with HN, the complication is less frequent with rates ranging from 0 to 32% [12-14, 22, 26, 28, 29, 34]. ...
... However, the type of osteosynthesis (LP or HN) shows no significant difference in rates of non-union [12-14, 26, 60], which is in line with our study. According to the literature the prevalence of nonunion varies between 0-13% with LP treatment [14,24,26,28,[39][40][41][42][43][44][45]61] and 0-2.6% with HN treatment [14,22,26,28,29,34]. The rate of non-union in our study was 16% and, therefore, slightly higher than in other studies. ...
PurposeThere is still disagreement regarding the optimal surgical treatment of three- and four-part fractures of the proximal humerus. The aim of this monocentric, retrospective study was to compare the complication rate of internal fixation with a locking plate versus proximal humeral nailing after a one-year follow-up.Methods
From 2005 to 2016, 292 patients suffered a fracture of the proximal humerus and were treated surgically at our level-I trauma center. According to the inclusion criteria, 50 patients were included in this study: 19 of these (11 three-part fractures and 8 four-part fractures) were treated with a proximal humeral nail (HN) and 31 (12 three-part fractures and 19 four-part fractures) with a locking plate (LP) osteosynthesis. Classification was performed according to the Hertel classification. At a 1-year follow-up, the complication rate of the two treatment methods was compared.ResultsTwenty patients (40%) suffered at least one complication. Of these, six patients (12%) were treated with a HN and 14 (28%) with a LP (p = 0.39). The most frequent complication was screw perforation (22%), followed by non-union (16%). Humeral head necrosis (10%) occurred only in the LP cohort. One wound infection occurred in a patient treated with a HN. Four-part fractures were treated more frequently with a LP. However, the difference was non-significant in this sample (p = 0.186).Conclusions
The results of our study provide some evidence that in terms of complication rate, both treatment options are comparable for internal fixation of three- and four-part fractures of the proximal humerus. The type of fracture seems to be decisive for the choice of implant.
... Early rehabilitation is fundamental for measuring patient's outcome and is directly related to the fracture pattern: the integrity and reduction of the greater and the lesser tubercles are important factors for shoulder's stability (23). Due to limited tissue exposure, MIPO has a lower incidence in avascular necrosis and infection and increase recovery time and early motion, when compared to ORFI using a deltopectoral approach (24). External fixators could be a valid alternative for elderly patients with osteoporosis and comorbidities as it is a mini-invasive surgery preserving soft tissues (25). ...
Background and aim of the work
Proximal humeral fractures incidence in the elderly population is increasing. Treatment management is complicated by fracture complexity and patients’ comorbidities. The aim of our prospective study is the outcome evaluation of the role of minimally invasive plate osteosynthesis (MIPO) for elderly patients with a 3- or 4-parts proximal humeral fractures having an intact medial wall.
Methods
N=45 patients were selected using inclusion criteria (>75yo, unilateral 3- or 4-parts proximal humeral fracture and with a surgical indication). We analyzed n=42 fractures treated with MIPO (3 patients had been reversed to ORIF and arthroplasty intraoperatively): n=20 4-parts fractures and n=22 were 3-parts. Of the 42 operated patients 17 identified as male and 25 as female (mean age 84yo). A trans-deltoid approach has been used with minimal surgical exposure and tissue damage to preserve the local tissue for early shoulder mobilization.
Results
At follow-up, the DASH recorded mean value was 72, while the Constant mean score was 68. Complications have been recorded in 23,8% of patients with 4-parts fractures having the highest complication frequency. Mean shoulder joint ROM was recorded: anterior elevation 75°, lateral elevation 80°, abduction 90°, intra-rotation 50°, extra-rotation 25°. The following factors were identified influencing the outcome: >8mm calcar fragment, head valgus impaction and periosteal medial hinge preservation.
Conclusions
The increase in population longevity matches the increase in complex humeral fracture frequency. We strongly for management consensus for proximal humerus fracture, in a similar way as for neck femoral fractures. MIPO is excellent in reducing soft tissue damage and complications for elderly patients with limited functional demand. (www.actabiomedica.it)
... At present, the main surgical procedures for simple avulsion fractures of the humeral greater tubercle are screw xation, suture anchor xation, and plate xation [3]. Among them, open reduction and internal xation with plates is widely used, but several problems, such as a larger incision, more damage to blood circulation and periosteum, in uence on fracture healing, and acromion impingement will be encountered [7]. Compared with conventional plates, locking plates bring important changes in fracture management, allowing exible biological fracture xation based on the principle of internal xators and reducing the incidence of failed bone healing [8,9]. ...
Background: This study aims to describe a new procedure of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.
Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. Endpoints were assessed preoperatively and postoperatively and included the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.
Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.
Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.
... At present, the main surgical procedures for simple avulsion fractures of the humeral greater tubercle are screw xation, suture anchor xation, and plate xation [3]. Among them, open reduction and internal xation with plates is widely used, but several problems, such as a larger incision, more damage to blood circulation and periosteum, in uence on fracture healing, and acromion impingement will be encountered [7]. Compared with conventional plates, locking plates bring important changes in fracture management, allowing exible biological fracture xation based on the principle of internal xators and reducing the incidence of failed bone healing [8,9]. ...
Background: This study aims to describe a modified surgical method of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.
Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. All patients were followed up with clinical examination and radiographs at 3 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery and then every 6 months. Outcomes were assessed preoperatively and postoperatively with the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.
Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.
Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.
... At present, the main surgical procedures for simple avulsion fractures of the humeral greater tubercle are screw xation, suture anchor xation, and plate xation [3]. Among them, open reduction and internal xation with plates is widely used, but several problems, such as a larger incision, more damage to blood circulation and periosteum, in uence on fracture healing, and acromion impingement will be encountered [7]. Compared with conventional plates, locking plates bring important changes in fracture management, allowing exible biological fracture xation based on the principle of internal xators and reducing the incidence of failed bone healing [8,9]. ...
Background: This study aims to describe a new procedure of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.
Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. Endpoints were assessed preoperatively and postoperatively and included the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.
Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.
Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.
... At present, the main surgical procedures for simple avulsion fractures of the humeral greater tubercle are screw xation, suture anchor xation, and plate xation [3]. Among them, open reduction and internal xation with plates is widely used, but several problems, such as a larger incision, more damage to blood circulation and periosteum, in uence on fracture healing, and acromion impingement will be encountered [7]. Compared with conventional plates, locking plates bring important changes in fracture management, allowing exible biological fracture xation based on the principle of internal xators and reducing the incidence of failed bone healing [8,9]. ...
Background: This study aims to describe a new procedure of minimally invasive open reduction by a modified suture bridge with anchors for avulsion-type greater tuberosity fracture of the humerus and to evaluate its clinical effectiveness.
Methods: From January 2015 to January 2018, 16 patients who were diagnosed with an avulsion-type greater tuberosity fracture of the proximal humerus and treated with minimally invasive open reduction by modified suture bridges with anchors were retrospectively studied. Endpoints were assessed preoperatively and postoperatively and included the visual analog scale (VAS), the University of California Los Angeles (UCLA) shoulders score, the American Shoulder and Elbow Surgeons score (ASES), and the range of motion (ROM) for shoulders.
Results: There were 7 males and 9 females with an average age of 44.94 years. Six fractures involved the left shoulder, and 10 involved the right shoulder. The time between injury and operation ranged from 1 to 5 days, with an average of 2.32 days. The average length of stay was 6.5 ± 0.85 days; the mean operation time was 103.1 ± 7.23 minutes; and the mean amount of operative blood loss was 51.88 ± 6.40 ml. All patients achieved bone union within 3 months after surgery. The VAS score significantly decreased at 3 weeks postoperatively (p = 0.002), as did the average degree of forward elevation (p = 0.047). The mean degree of abduction increased at 6 weeks after the operation (p = 0.035), and the average degree of external rotation and internal rotation improved at 3 months postoperatively (p = 0.012; p = 0.007). The ASES score and the UCLA score improved at the 6-week follow-up (p = 0.092; p = 0.029). No procedure-related death or incision-related superficial or deep tissue infection was identified in any case. No iatrogenic neurovascular injuries or fractures were found in this study.
Conclusion: The fracture block was fixed firmly by minimally invasive open reduction with a modified suture bridge with anchors. Patients were allowed to move their shoulder early after surgery and recovered quickly. It is an efficient method for the treatment of avulsion-type greater tuberosity fractures of the humerus.
