MIPO with helical plate in humeral fracture

Authors

Keywords:

húmero, fractura diafisiaria, multifragmentaria, philos helicoidal, mipo.

Abstract

Introduction: Multifragmentary diaphyseal humeral fractures with proximal extension are infrequent patterns of injury caused mainly by high-energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the proximity of the radial nerve to the radial groove represent challenges to be treated, therefore minimally invasive incisions and fracture stabilization with the proximal humeral internal locking system plate are recommended.

Objective: To establish the efficacy of the minimally invasive plate osteosynthesis technique with helical molding of the proximal humeral plate internal locking system.

Case report: We report the case of a 29-year-old patient who suffered a traffic accident and had a multifragmentary diaphyseal fracture extended to the proximal humerus. He was treated with the minimally invasive plate osteosynthesis technique and the humeral proximal helical plate internal locking system. He achieved complete consolidation and rapid functional recovery.

Conclusions: The minimally invasive plate osteosynthesis technique with the humeral proximal helical plate internal locking system is an effective and safe surgical option for multifragmentary diaphyseal humeral fractures with proximal extension, since it preserves the deltoid muscle insertion, improves bone-plate contact with minimal risk of fracture. Axillary and radial neurological injury, promotes bone healing and improves functional outcome.

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Author Biography

Renán Estuardo Vargas Morales, Universidad Privada Antenor Orrego

Traumatólogo Ortopedista del Hospital Víctor Lazarte Echegaray de Trujillo. Docente de Cirugía I, Escuela de Medicina Humana, Universidad Privada Antenor Orrego.

References

Nicolaci G, Lollino N. How to treat proximal and middle one-third humeral shaft fractures: The role of helical plates. Surgical Techniques Development. 2021;10(1):9175. DOI: https://doi.org/10.4081/std.2021.9175

Zamboni C, Durigan JF, Diaz Pimentel F, Soares Hungria J, Tomanik Mercadante M, de Moraes Barros, PM. Rotational evaluation of humeral shaft fractures with proximal extension fixed using the MIPO technique. Injury, Int. J. Care Injured. 2018;49(8):1558-61. DOI: https://doi.org/10.1016/j.injury.2018.06.017

Da Silva T, Rummel F, Knop C. Comparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases. Arch Orthop Trauma Surg. 2020;140:1931-7. DOI: https://doi.org/10.1007/s00402-020-03438-y

Moon J, Kwon H, Biraris S, Shon W. Minimally Invasive Plate Osteosynthesis Using a Helical Plate for Metadiaphyseal Complex Fractures of the Proximal Humerus. Orthopedics. 2014;37(3):e237-43. DOI: https://doi.org/10.3928/01477447-20140225-55

Narayanan V, Balasubramanian N. Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients. Malaysian Orthopaedic Journal. 2018;12(2):20-4. DOI: http://dx.doi.org/10.5704/MOJ.1807.004

Levy B, Herrera D, Templeman D, Cole P. Segmental Proximal Humerus Fractures: A Case Report of Submuscular Plating. J Trauma. 2008;65(6):1554-7. DOI: https://doi.org/10.1097/01.ta.0000215382.66954.54

Rupenian P, Lebas G, Raza F, Herrador M, D´assaro O. Osteosíntesis mínimamente invasiva con placa helicoidal en fracturas diafisarias del húmero con compromiso del tercio proximal. Informe de un caso y descripción de la técnica. Rev Asoc Argent Ortop Traumatol. 2005 [acceso 10/10/2021];70(3):252-5. Disponible en: http://www.aaot.org.ar/revista/2005/n3_vol70/art10.pdf

Belangero W, Zublin C, Cárdenas R, Suárez F, Alvachian H, Martinez S, et al. Quick-DASH as a main early outcome of humeral shaft fractures: A Latin American multicenter prospective study. Journal of Orthopaedic Surgery. 2020;28(2):1-7. DOI: https://doi.org/10.1177/2309499020929436

Da Silva T, Rummel F, Knop C, Merkle T. Shoulder function after helical long PHILOS plate. Eur J Orthop Surg Traumatol. 2021;31:1463-9. DOI: https://doi.org/10.1007/s00590-021-02908-2

Dauwe J, Grechenig P, Unterfrauner I, Schwarz A, Weiglein A, Hohenberger G. Axillary nerve elongation in humeral fracture plating: A cadaveric study for comparison between straight and helical Philos plates. J Orthop. 2020;19:233-6. DOI: https://doi.org/10.1016/j.jor.2020.02.009

Maes V, Putzeys G. One-Year Follow-Up After Treatment of Proximal and/or Middle One-Third Humeral Shaft Fractures with a Helical Plate: Healing Rates, Complications and Functional Outcome Measures. 2019. DOI: https://doi.org/10.21203/rs.3.rs-329533/v1

Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018, Journal of Orthopaedic Trauma. 2018;32:1-0. DOI: https://doi.org/10.1097/BOT.0000000000001063

Byun Y, Shin D, Park Y, Kim M, Gu T, Han J. Helical Plating for Fractures of the Proximal Humeral Shaft. J Korean Orthop Assoc. 2017;52(3):232-9. DOI: https://doi.org/10.4055/jkoa.2017.52.3.232

García-Virto V, Santiago-Maniega S, Llorente-Peris A, Simón-Pérez C, Álvarez-Ramos B, García-Florez L, et al. MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results. Injury. 2021;52(Supl4):125-30. DOI: https://doi.org/10.1016/j.injury.2021.01.049

Ekdahl M, Domínguez C, Pinedo M, López S, Gutiérrez V. New precontoured long locking plate for proximal metadiaphyseal fractures of the humerus: a cadaveric study for its use with the minimally invasive technique. JSES Int. 2021;5(3):540-5. DOI: https://doi.org/10.1016/j.jseint.2020.12.010

Touloupakis G, Di Giorgio L, Bibiano L, Biancardi E, Ghirardelli S, Sinno E, et al. Exploring the difficulties to improve minimally invasive application with long PHILOS plate in multifocal metadiaphyseal fractures of the proximal humerus: analysis of intraoperative procedure and clinical outcomes. Acta Biomed. 2018;89(4):532-9. DOI: https://doi.org/10.23750/abm.v89i4.6212

Zamboni C, Carmo B, Moraes L, Hungría J, Mercadante M, Fucs P. A practical guide for the use of contour locking plates for the repair of humeral diaphyseal fractures with proximal extension. Injury. 2019;50(12): 2247-51. DOI: https://doi.org/10.1016/j.injury.2019.09.026

Published

2022-11-12

How to Cite

1.
Vargas Morales RE, Zavaleta Alfaro RL, Lozano Peralta KY. MIPO with helical plate in humeral fracture. Revista Cubana de Ortopedia y Traumatologí­a [Internet]. 2022 Nov. 12 [cited 2025 Apr. 3];36(4). Available from: https://revortopedia.sld.cu/index.php/revortopedia/article/view/499

Issue

Section

Presentación de casos