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Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds of humeral shaft fractures

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Abstract

Purpose

Options for the treatment of proximal- and middle-thirds of humeral shaft fractures include intramedullary interlocking nail (IMN) and minimally invasive plate osteosynthesis (MIPO). However, whether IMN provides better clinical outcomes than MIPO surgical technique still remains unclear. This study was designed to compare clinical outcomes of the IMN with MIPO technique for the treatment of proximal- and middle-thirds of humeral shaft fractures.

Method

A retrospective cohort analysis of 55 proximal- and middle-thirds of humeral shaft fractures surgically treated using IMN (n = 25) or MIPO (n = 30) from January 2012 to January 2016. Peri-operative and follow-up data (a minimum of 1 year) of the patients (aged from 18 to 56 years) were collected. Operative time, union time, VAS scores, surgery-related complications, and implant removal rate were compared between the two groups in this study. Besides, the functional outcomes were evaluated using the Rating Scale of American Shoulder and Elbow Surgeons’ Form (ASES) and Mayo Elbow Performance Score System (MEPS).

Result

We found significantly shorter operative time and much less blood loss in IMN group, and lower VAS scores in the IMN group after surgery at first and third months but not at the sixth month. Complication rate was found to be relatively higher in the MIPO group when compared to the IMN group. No significant difference was observed between these two groups regarding ASES and MEPS scores. Three patients in the MIPO group suffered iatrogenic radial nerve injury and recovered after four to five months later. No implant failures occurred in either group.

Conclusion

Intramedullary interlocking nail seemed to be superior to minimally invasive plate osteosynthesis in the treatment of proximal- and middle-thirds of humeral shaft fractures due to shorter operative time and union time, less early post-operative pain, and fewer complications. The intramedullary interlocking nail could be considered a better surgical option for the management of proximal middle humeral fractures, though it may also depend on the surgeons’ skills and learning curve. Further in-depth prospective studies are in great need to verify our conclusion.

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Data Availability

All the data and materials are available upon requests from the corresponding author.

References

  1. Cole PA, Wijdicks CA (2007) The operative treatment of diaphyseal humeral shaft fractures. Hand Clin 23(4):437–448. https://doi.org/10.1016/j.hcl.2007.11.004

    Article  PubMed  Google Scholar 

  2. Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S (2006) Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg (Br) 88(11):1469–1473. https://doi.org/10.1302/0301-620X.88B11.17634

    Article  CAS  Google Scholar 

  3. Singisetti K, Ambedkar M (2010) Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop 34(4):571–576. https://doi.org/10.1007/s00264-009-0813-2

    Article  PubMed  Google Scholar 

  4. Pospula W, Abu Noor TA (2006) Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi hospital, Kuwait. Med Princ Pract 15(6):423–426. https://doi.org/10.1159/000095487

    Article  PubMed  Google Scholar 

  5. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S (2005) Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury 36(4):530–538. https://doi.org/10.1016/j.injury.2004.05.036

    Article  CAS  PubMed  Google Scholar 

  6. Bradley D, Arshad MS, Aster A, Jeyam M (2013) Spontaneous recovery of radial nerve function following axonamonosis caused by impingement from distal locking screws during humeral nailing. Should Elb 5(3):202–205

    Article  Google Scholar 

  7. Baltov A, Mihail R, Dian E (2014) Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury 45:S9–S15

    Article  Google Scholar 

  8. Gosler MW, Testroote M, Morrenhof JW, Janzing HM (2012) Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database Syst Rev 1:CD008832. https://doi.org/10.1002/14651858.CD008832.pub2

    Article  PubMed  Google Scholar 

  9. Lian K, Wang L, Lin D, Chen Z (2013) Minimally invasive plating osteosynthesis for mid-distal third humeral shaft fractures. Orthopedics 36(8):e1025–e1032

    Article  Google Scholar 

  10. Shetty MS, Kumar MA, Sujay K, Kini AR, Kanthi KG (2011) Minimally invasive plate osteosynthesis for humerus diaphyseal fractures. Indian J Orthop 45(6):520–526. https://doi.org/10.4103/0019-5413.87123

    Article  PubMed  PubMed Central  Google Scholar 

  11. Concha JM, Sandoval A, Streubel PN (2010) Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? Int Orthop 34(8):1297–1305. https://doi.org/10.1007/s00264-009-0893-z

    Article  PubMed  Google Scholar 

  12. Yang T, Liu S, Liu Y (2007) Minimally-invasive locking compression plate to treat complex humeral shaft fracture. Chin J ReparativeReconstr Surg 21(8):817–819

    Google Scholar 

  13. An Z, He X, Zeng B (2009) A comparative study on open reduction and plating osteosynthesis and minimal invasive plating osteosynthesis in treating mid-distal humeral shaft fractures. Chin J ReparativeReconstr Surg 23(1):41–44

    Google Scholar 

  14. Vander Griend RA, Ward EF, Tomasin J (1985) Closed Kuntscher nailing of humeral shaft fractures. J Trauma 25(12):1167–1169

    Article  CAS  Google Scholar 

  15. Brumback RJ, Bosse MJ, Poka A, Burgess AR (1986) Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg Am 68(7):960–970

    Article  CAS  Google Scholar 

  16. Chen CM, Chiu FY, Lo WH (2000) Treatment of acute closed humeral shaft fractures with Ender nails. Injury 31(9):683–685

    Article  CAS  Google Scholar 

  17. Flinkkila T, Hyvonen P, Lakovaara M, Linden T, Ristiniemi J, Hamalainen M (1999) Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 70(2):133–136

    Article  CAS  Google Scholar 

  18. Durbin RA, Gottesman MJ, Saunders KC (1983) Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res 179:168–174

    Article  Google Scholar 

  19. Hall RF Jr, Pankovich AM (1987) Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am 69(4):558–567

    Article  Google Scholar 

  20. Mauch J, Renner N, Rikli D (2000) Intramedullary nailing of humeral shaft fractures--initial experiences with an unreamed humerus nail. Swiss Surg 6(6):299–303

    Article  CAS  Google Scholar 

  21. Gierer P, Scholz M, Beck M, Schaser KD, Vollmar B, Mittlmeier T, Gradl G (2010) Microcirculatory sequelae of the rotator cuff after antegrade nailing in proximal humerus fracture. Arch Orthop Trauma Surg 130(5):687–691. https://doi.org/10.1007/s00402-009-0956-z

    Article  PubMed  Google Scholar 

  22. Ikpeme JO (1994) Intramedullary interlocking nailing for humeral fractures: experiences with the Russell-Taylor humeral nail. Injury 25(7):447–455

    Article  CAS  Google Scholar 

  23. Changulani M, Jain UK, Keswani T (2007) Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop 31(3):391–395. https://doi.org/10.1007/s00264-006-0200-1

    Article  CAS  PubMed  Google Scholar 

  24. Chapman JR, Henley MB, Agel J, Benca PJ (2000) Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma 14(3):162–166

    Article  CAS  Google Scholar 

  25. Raghavendra S, Bhalodiya HP (2007) Internal fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: a prospective study. Indian J Orthop 41(3):214–218. https://doi.org/10.4103/0019-5413.33685

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Konda SR, Saleh H, Fisher N, Egol KA (2017) Humeral shaft fracture: intramedullary nailing. J Orthop Trauma 31(Suppl 3):S38. https://doi.org/10.1097/BOT.0000000000000898

    Article  PubMed  Google Scholar 

  27. Fan Y, Li YW, Zhang HB, Liu JF, Han XM, Chang X, Weng XS, Lin J, Zhang BZ (2015) Management of humeral shaft fractures with intramedullary interlocking nail versus locking compression plate. Orthopedics 38(9):e825–e829. https://doi.org/10.3928/01477447-20150902-62

    Article  PubMed  Google Scholar 

  28. Chen YN, Chang CW, Lin CW, Wang CW, Peng YT, Chang CH, Li CT (2017) Numerical investigation of fracture impaction in proximal humeral fracture fixation with locking plate and intramedullary nail. Int Orthop 41(7):1471–1480. https://doi.org/10.1007/s00264-017-3401-x

    Article  PubMed  Google Scholar 

  29. An Z, He X, Jiang C, Zhang C (2012) Treatment of middle third humeral shaft fractures: minimal invasive plate osteosynthesis versus expandable nailing. Eur J Orthop Surg Traumatol 22(3):193–199

    Article  Google Scholar 

  30. Kulkarni VS, Kulkarni MS, Kulkarni GS, Goyal V, Kulkarni MG (2017) Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures. Injury 48:S8–S13

    Article  Google Scholar 

  31. Wang C, Li J, Li Y, Dai G, Wang M (2015) Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique? J Shoulder Elb Surg 24(11):1741–1748

    Article  Google Scholar 

  32. Spiguel AR, Steffner RJ (2012) Humeral shaft fractures. Curr Rev Musculoskelet Med 5(3):177–183. https://doi.org/10.1007/s12178-012-9125-z

    Article  PubMed  PubMed Central  Google Scholar 

  33. Davies G, Yeo G, Meta M, Miller D, Hohmann E, Tetsworth K (2016) Case-match controlled comparison of minimally invasive plate osteosynthesis and intramedullary nailing for the stabilization of humeral shaft fractures. J Orthop Trauma 30(11):612–617. https://doi.org/10.1097/BOT.0000000000000643

    Article  PubMed  Google Scholar 

  34. Bhandari M, Devereaux PJ, McKee MD, Schemitsch EH (2006) Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis. Acta Orthop 77(2):279–284. https://doi.org/10.1080/17453670610046037

    Article  PubMed  Google Scholar 

  35. Ma JX, Xing D, Ma XL, Gao F, Wei Q, Jia HB, Feng R, Yu JT, Wang J (2013) Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis. PLoS One 8(12):ARTN e82075. https://doi.org/10.1371/journal.pone.0082075

    Article  CAS  Google Scholar 

  36. Dai J, Chai Y, Wang C, Wen G (2014) Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures: a meta-analysis of RCTs and nonrandomized studies. J Orthop Sci 19(2):282–291. https://doi.org/10.1007/s00776-013-0497-8

    Article  PubMed  Google Scholar 

  37. Hohmann E, Glatt V, Tetsworth K (2016) Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials. J Shoulder Elb Surg 25(10):1634–1642. https://doi.org/10.1016/j.jse.2016.05.014

    Article  Google Scholar 

  38. Hu X, Xu S, Lu H, Chen B, Zhou X, He X, Dai J, Zhang Z, Gong S (2016) Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis. J Orthop Surg Res 11(1):59. https://doi.org/10.1186/s13018-016-0394-x

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zhao JG, Wang J, Meng XH, Zeng XT, Kan SL (2017) Surgical interventions to treat humerus shaft fractures: a network meta-analysis of randomized controlled trials. PLoS One 12(3):ARTN e0173634. https://doi.org/10.1371/journal.pone.0173634

    Article  CAS  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (81701364).

Author information

Author notes

  1. Yao Wang and Huiwen Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics Trauma, Shanghai Changhai Hospital, Naval Military Medical University, Yangpu District, Shanghai, 200433, China

    Yao Wang, Huiwen Chen, Lin Wang, Xiao Chen, Xin Zhi & Jin Cui

  2. Basic Medical School, Naval Military Medical University, Yangpu District, Shanghai, 200433, China

    Xin Zhi

  3. Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Baoshan District, Shanghai, 201908, China

    Liehu Cao

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  1. Yao Wang
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  3. Lin Wang
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Contributions

YW, HC, and LC: study design and performance. XZ and JC: data collection and data analysis. XC: data interpretation. YW, HC, and LW: drafting manuscript. LC: revising manuscript content. LC: supporting the study and approving the final version of the manuscript. All authors approved the submitted version.

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Correspondence to Liehu Cao.

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All authors declare that they have no conflicts of interest.

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This research study was conducted retrospectively from data obtained for clinical purposes. Approval from the ethical committee of Changhai Hospital and informed consent of enrolled patients were obtained prior to initiating data collection.

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Wang, Y., Chen, H., Wang, L. et al. Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds of humeral shaft fractures. International Orthopaedics (SICOT) 45, 2093–2102 (2021). https://doi.org/10.1007/s00264-020-04869-3

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