Functional outcomes of minimal invasive percutaneous plate osteosynthesis (MIPPO) in humerus shaft fractures: A clinical study

Objective: We aimed to evaluate the objective and subjective outcomes of humerus shaft fractures treated with minimal invasive percutaneous plate osteosynthesis and emphasize points which may enhance clinical outcomes and simplify the procedure. Methods: The retrospective study included 14 patients (mean age: 41.7 years; range: 19 to 66 years) with humerus mid-shaft fractures treated with the MIPPO technique between 2009 and 2011. 4.5-mm locking plates were applied via an anterior approach and advanced antegradely (proximal to distal) to protect the integrity of the deltoid insertion. Fracture healing was evaluated using plain radiographs. Objective outcomes were assessed in terms of range of motion and subjective outcomes using the American Shoulder and Elbow Society (ASES), University of California, Los Angles (UCLA), Mayo Elbow Performance Index (MEPI) and The Disability of The Arm, Shoulder and Hand (DASH) scores. Results: Satisfactory outcomes with successful union were obtained within a mean of 17.8 (range: 13 to 30) months. While the average active forward flexion of shoulder was 163.9°±5.6°, the mean abduction was 87.8°±3.77°. Mean elbow flexion and extension loss was 134.6°±41.16° and 3.9°±6.25°, respectively. Mean ASES and UCLA scores were 90.2±4.76 and 31.8±1.56 and mean MEPI and DASH score were 93.6±4.12 and 4.6±2.19, respectively. Conclusion: Minimal invasive percutaneous plate osteosynthesis appears to be a successful technique for the treatment of humerus shaft fractures. The procedure may be simplified and outcomes improved by engaging the plate with the anterior surface of the humerus during advancement, antegrade advancement of the plate to protect deltoid insertion and using of a minimum of 6 cortices for each side of the fracture to provide stable fixation.