Session IX - Upper Extremity

Sat., 10/12/13 Upper Extremity, PAPER #99, 2:38 pm OTA 2013

A Prospective Randomized Study of Operative Treatment for Noncomminuted, Humeral Shaft Fractures: Open Plating Versus Minimally Invasive Plate Osteosynthesis (MIPO)

Kichul Park, MD1; Chang-Wug Oh, MD2; Young-Soo Byun, MD3; Jung Jae Kim, MD4; Ji Wan Kim, MD5;
1Hanyang University Guri Hospital, Hanyang University, Guri, Repulbic of Korea;
2Kyungpook National Hospital, Kyungpook National University, Dae-gu, Republic of Korea;
3Daegu Fatima Hospital, Daegu, Republic of Korea;
4Asan Medical Center, University of Ulsan, Seoul, Republic of Korea;
5Haeundae Paik Hospital, Inje University, Busan, Republic of Korea

Purpose: This study was prospectively designed to compare the clinical and radiologic results for open plating and minimally invasive plate osteosynthesis (MIPO) in the treatment of simple-type humeral shaft fractures. The hypothesis was that the clinical result in the MIPO group would be the same or superior to that of the conventional plating group.

Methods: From June 2011 to Dec 2011, 68 patients presented to five Level I trauma centers. These patients were prospectively randomized into an open plating group (32 cases) and MIPO group (36 cases). All patients had average 15-month follow-up with minimum 12 months. Clinical outcome measurements included fracture healing time, operation time, radiation exposure time, intraoperative nerve injury, and elbow and shoulder function. Complications such as infection, nonunion, and malunion were also evaluated. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion.

Results: 31 fractures (97%) in the open plating group were healed by 16 weeks versus 36 fractures (100%) in the MIPO group by 15 weeks (P = 0.588). Blood loss was 185 mL in open plating group and 102 mL in the MIPO group and it showed significant difference statistically (P <0.001). Time of radiation exposure was 10 seconds in the open plating group and 68 seconds in the MIPO group (P <0.001). There was no difference in operation time (116 minutes vs 105 minutes, P =0.106) or complication rate. Both groups had excellent radiologic result and functional outcomes of the elbow and shoulder and there were no differences.

Conclusion: For patients requiring surgical treatment of a noncomminuted humeral shaft fracture, both open plating and MIPO both provide predictable results for achieving fracture healing with excellent elbow and shoulder function.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.