Abstract
In the last few years there has been great interest in minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. None of these studies showed the anatomical relationship between the radial nerve and the material of the implant in vivo. We performed postoperative ultrasonographic measurement of the distance between the radial nerve and the material implanted using the MIPO technique. Nineteen patients underwent postoperative ultrasound examinations. Group A comprised midshaft fractures and group B distal third fractures. The point of greatest proximity between the radial nerve and the implant was measured. In group A the distance was between 1.6 and 19.6 mm (mean: 9.3 mm) and in group B between 1.0 and 8.1 mm (mean: 4.0 mm). The ultrasound findings reveal that the radial nerve is quite close to the implant material, especially in the transition between the third and fourth quarters of the humeral shaft.
Résumé
Ce travail est l’étude par ultrasonographie des rapports entre le nerf radial et la plaque implantée par technique mini invasive (MIPO) dans le traitement des fractures de la diaphyse humérale. Dix neuf patients sont étudiés avec fracture à mi-diaphyse pour le groupe A et fracture du 1/3 distal pour le groupe B. Le point de plus grande proximité entre l’implant et le nerf a été mesuré: entre 1,6 et 19,6 mm pour le groupe A (moyenne 9,3 mm) et entre 1,0 et 8,1 mm pour le groupe B (moyenne 4,0 mm). L’étude montre la proximité entre le nerf radial et le matériel surtout à l’union 3/4 proximal et 1/4 distal.
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References
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
Bodner G, Buchberger W, Schocke M, Bale R, Huber B, Harpf C, Gassner E, Jaschke W (2001) Radial nerve palsy associated with humeral shaft fracture: evaluation with US-initial experience. Radiology 219(3):811–816
Bodner G, Huber B, Schwabegger A, Lutz M, Waldenberger P (1999) Sonographic detection of radial nerve entrapment within a humerus fracture. J Ultrasound Med 18(10):703–706
Fernández Dell’Oca AA (2002) The principle of helical implants. Unusual ideas worth considering. Injury 33(Suppl 1):SA1–SA27
Hernández S, Dario R (2003) Placa puente en húmero. Perspectiva de una técnica. Rev Colomb Ortop Traumatol 17(3):69–73
Holstein A, Lewis GM (1963) Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am 45:1382–1388
Jiang R, Luo CF, Zeng BF, Mei GH (2007) Minimally invasive plating for complex humeral shaft fractures. Arch Orthop Trauma Surg 127(7):531–535
Lau TW, Leung F, Chan CF, Chow SP (2007) Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture. Int Orthop 31(5):657–664
Livani B, Belangero WD (2004) Osteossíntese de fratura diafisária do úmero com placa em ponte: apresentação e descrição da técnica. Acta Ortop Bras 12(2):112–117
Livani B, Belangero WD (2004) Bridging plate osteosynthesis of humeral shaft fractures. Injury 35(6):587–595
Livani B, Belangero WD, Castro de Medeiros R (2006) Fractures of the distal third of the humerus with palsy of the radial nerve: management using minimally-invasive percutaneous plate osteosynthesis. J Bone Joint Surg Br 88(12):1625–1628
Numbela BX, Aceves LH, González AB, Castro CT (2007) Minimally invasive surgery in diaphyseal humeral fractures with helicoidal plate. One year result in seven patients (in Spanish). Acta Ortop Mex 21(05):239–426
Pospula W, Abu Noor T (2006) Percutaneous fixation of comminuted fractures of the humerus: initial experience at Al Razi hospital, Kuwait. Med Princ Pract 15(6):423–426
Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 87(12):1647–1652
Sisk TD (1987) Fractures of shoulder girdle and upper extremity. In: Crenshaw AH (ed) Campbell’s operative orthopaedics, vol 3, 7th edn. Mosby, St. Louis, pp 1794–1799
Testut L, Latarjet A (1954) Tratado de anatomía humana, vol III. Salvat Editores, Barcelona, pp 305–312
Testut L, Jacob O (1977) Tratado de anatomía topográfica con aplicaciones medicoquirúrgicas, vol II. Salvat Editores, Barcelona, pp 708–723
Whitson RO (1954) Relation of the radial nerve to the shaft of the humerus. J Bone Joint Surg Am 36(1):85–88
Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H (2007) Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma 21(9):628–633
Ziran BH, Belangero WD, Livani B, Pesantez R (2007) Percutaneous plating of the humerus with locked plating: technique and case report. J Trauma 63(1):205–210
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Livani, B., Belangero, W., Andrade, K. et al. Is MIPO in humeral shaft fractures really safe? Postoperative ultrasonographic evaluation. International Orthopaedics (SICOT) 33, 1719–1723 (2009). https://doi.org/10.1007/s00264-008-0616-x
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DOI: https://doi.org/10.1007/s00264-008-0616-x