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Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures

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To describe the surgical application of anterior minimally invasive plating osteosynthesis (MIPO) using reversed proximal humerus internal locking system (PHILOS) plate for multifragmentary distal humeral shaft fractures.


Twelve patients with distal humeral shaft fractures (type 12B, n = 6 and type 12C, n = 6) were operated on by anterior MIPO and reversed PHILOS plate fixation. The amount of intact bone in the distal fragment was measured by fracture-to-coronoid distance (FCD). Data of the postoperative alignment, complications, union time, and clinical outcomes were collected.


The mean time for fractures to unite in all patients was 14.8 weeks (range 12–22). There was no perioperative complication. The mean FCD was 4.8 cm (range 2.1–8.1). The mean coronal angulation was 3.4° (range 0–9), and the mean sagittal angulation was 1° (range 0–5). All patients had excellent UCLA shoulder score and MEP score results, and the mean range of elbow motion was 140° (range 130–145).


Anterior MIPO using reversed PHILOS plate is safe and effective for multifragmentary fractures of the distal humeral shaft even in a fracture with a length of intact bone above the coronoid fossa of only 2 cm.

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  1. Volgas DA, Stannard JP, Alonso JE (2004) Nonunions of the humerus. Clin Orthop Relat Res 419:46–50

    Article  Google Scholar 

  2. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82(4):478–486

    Article  CAS  Google Scholar 

  3. Ekholm R, Tidermark J, Törnkvist H, Adami J, Ponzer S (2006) Outcome after closed functional treatment of humeral shaft fractures. J Orthop Trauma 20(9):591–596

    Article  Google Scholar 

  4. An Z, Zeng B, He X, Chen Q, Hu S (2010) Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 34(1):131–135

    Article  Google Scholar 

  5. Jawa A, McCarty P, Doornberg J, Harris M, Ring D (2006) Extra-articular distal-third diaphyseal fractures of the humerus. a comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88(11):2343–2347

    Article  Google Scholar 

  6. 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

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  8. Lin J, Shen PW, Hou SM (2003) Complications of locked nailing in humeral shaft fractures. J Trauma 52(5):943–949

    Article  Google Scholar 

  9. Scheerlinck T, Handelberg F (2002) Functional outcome after intramedullary nailing of humeral shaft fractures: comparison between retrograde marchetti-vicenzi and unreamed ao antegrade nailing. J Trauma 52(1):60–71

    PubMed  Google Scholar 

  10. 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

    Article  CAS  Google Scholar 

  11. Pospula W, 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

    Article  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. Kobayashi M, Watanabe Y, Matsushita T (2010) Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma 24(4):212–216

    Article  Google Scholar 

  14. Shin S-J, Sohn H-S, Do N-H (2012) Minimally invasive plate osteosynthesis of humeral shaft fractures. J Orthop Trauma 26(10):585–589

    Article  Google Scholar 

  15. Oh CW, Byun YS, Oh JK, Kim JJ, Jeon IH, Lee JH et al (2012) Plating of humeral shaft fractures: comparison of standard conventional plating versus minimally invasive plating. Orthop Traumatol Surg Res 98(1):54–60

    Article  Google Scholar 

  16. Lee HJ, Oh CW, Oh JK, Apivatthakakul T, Kim JW, Yoon JP et al (2013) Minimally invasive plate osteosynthesis for humeral shaft fracture: a reproducible technique with the assistance of an external fixator. Arch Orthop Trauma Surg 133(5):649–657

    Article  Google Scholar 

  17. Gallucci G, Boretto J, Vujovich A, Alfie V, Donndorff A, De Carli P (2014) Posterior minimally invasive plate osteosynthesis for humeral shaft fractures. Tech Hand Up Extrem Surg 18(1):25–30

    Article  Google Scholar 

  18. Balam KM, Zahrany AS (2014) Posterior percutaneous plating of the humerus. Eur J Orthop Surg Traumatol 24(5):763–768

    Article  Google Scholar 

  19. Gallucci GL, Boretto JG, Alfie VA, Donndorff A, De Carli P (2015) Posterior minimally invasive plate osteosynthesis (MIPO) of distal third humeral shaft fractures with segmental isolation of the radial nerve. Chir Main 34(5):221–226

    Article  CAS  Google Scholar 

  20. Ji F, Tong D, Tang H, Cai X, Zhang Q, Li J et al (2009) Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique applied in the treatment of humeral shaft distal fractures through a lateral approach. Int Orthop 33(2):543–547

    Article  Google Scholar 

  21. Park JH, Kim JW, Oh CH, Choi KS, Hong JY, Kim JG (2015) PHILOS plate osteosynthesis in metaphyseal fractures of the distal humerus through an anterolateral approach. Clin Shoulder Elb 18(3):128–132

    Article  Google Scholar 

  22. Twaij H, Damany D (2013) PHILOS humerus plate for a distal tibial fracture. J Surg Case Rep 2013(1):rjs036

    Article  Google Scholar 

  23. Cortes LE, Triana M, Vallejo F, Slongo TF, Streubel PN (2011) Adult proximal humerus locking plate for the treatment of a pediatric subtrochanteric femoral nonunion: a case report. J Orthop Trauma 25(7):e63–e67

    Article  Google Scholar 

  24. Shearman AD, Eleftheriou KI, Patel A, Pradhan R, Rosenfeld PF (2016) Use of a proximal humeral locking plate for complex ankle and hindfoot fusion. J Foot Ankle Surg 55(3):612–618

    Article  Google Scholar 

  25. Lee T, Yoon J (2016) Newly designed minimally invasive plating of a humerus shaft fracture; a different introduction of the plate. Int Orthop 40(12):2597–2602

    Article  Google Scholar 

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Authors and Affiliations



SJ was involved in drafting and revising the manuscript for content, including medical writing for content, study concept and design, analysis, and interpretation of data, as well as acquisition of the data. AG, NN, and WT were involved in revising the manuscript for content and analysis and interpretation of data.

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Correspondence to Surasak Jitprapaikulsarn.

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S. Jitprapaikulsarn, N. Neti, W. Thremthakanpon and A. Gromprasit declare that they have no conflict of interest.

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This study has been approved by the ethical committees of Buddhachinaraj Hospital in accordance with the Declaration of Helsinki.

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Jitprapaikulsarn, S., Neti, N., Thremthakanpon, W. et al. Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures. Eur J Orthop Surg Traumatol 30, 1515–1521 (2020).

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