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The advantages of humeral anteromedial plate osteosynthesis in the middle third shaft fractures

Vorteile der anteromedialen Plattenlage bei Osteosynthese der Frakturen im mittleren Drittel des Humerusschaftes

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Zusammenfassung

HINTERGRUND: 1,2 % aller Frakturen entfallen auf Humerusschaftfrakturen, die unter etwas jüngeren Altersgruppen verzeichnet werden. Stolpern, Abstürze oder Verkehrsunfälle zählen zu den Ursachen, obwohl diese Frakturen auch pathologisch bedingt sein können. Um die Frage zu klären, welche von den zwei chirurgischen Behandlungen, die in unserer Abteilung für Behandlung von Humerusschaftfrakturen durchgeführt werden mehr Vorteile aufweist (anterolaterale oder anteromediale Platte durch anterolaterale Methode), haben wir die Inzidenz der postoperativen iatrogenischen Radialislähmungen und die jeweilige durchschnittliche Operationsdauer analysiert. METHODEN: Im Zeitraum von Januar 1992 bis Dezember 2009 wurden an der Traumatologie der chirurgischen Abteilung des Klinikzentrums Rijeka (KBC Rijeka) Frakturen im mittleren Drittel des Humerusschaftes von 420 Patienten (340 männliche und 80 weibliche Patienten im Durchschnittsalter von 38,11 ± 9,29 Jahren) behandelt. Dabei wurde die anterolaterale Methode und die interne Fixation mit Hilfe von AO/DCP oder LCP-Platten angewandt, die bei 141 Patienten (33,57 %) auf die anteromediale und bei 279 Patienten (66,43 %) auf die anterolaterale Humerusfläche gelegt wurde. ERGEBNISSE: Kein Patient, bei dem die Platte in der Osteosynthese auf der anteromedialen Humerusfläche angewandt wurde, hatte Läsion des Radialnervs. Demzufolge zeigte der χ2 Test eine erheblich höhere Häufigkeit von postoperativen Verletzungen des Radialnervs bei denjenigen Patienten, bei den die anterolaterale Platte angewandt worden ist als bei denjenigen, bei denen die anteromediale Platte gelegt worden ist (χ2 = 17,51; p < 0,05). Die Anwendung der anterolateralen Platte benötigte eine längere durchschnittliche Operationszeit als die der anteromedialen Platte. Die unterschiedliche Dauer, bestimmt durch den t-Test für unabhängige Muster, zeigte einen statistisch bedeutenden Unterschied. (t= 14,57; p< 0,05). SCHLUSSFOLGERUNG: Die Anwendung der anteromedialen Platte bei Humerusschaftfrakturen durch anterolaterale Methode hat sich als einfache, sichere, wirksame und als schnelle chirurgische Behandlung erwiesen. Demzufolge wird unsererseits diese Operationstechnik zur Behandlung von Humerusschaftfrakturen nachdrücklich empfohlen.

Summary

BACKGROUND: Humeral shaft fractures account for 1.2% of all fractures and occur in a slightly younger population. Their causes include a fall from standing or from height, motor vechicle accident, but can be also pathological. In order to clarify which of both surgeries we performed in our Department for treating humeral shaft fractures had more advantages (anterolateral or anteromedial plating through anterolateral approach) we analyzed incidence of postoperative iatrogenic radial palsies and mean operation time required to complete each surgery. METHODS: During January 1992 to December 2009 on Department of Surgery, Division for Traumatology of Clinical Hospital Center Rijeka, 420 patients (340 males and 80 females with mean age of 38.11 ± 9.29 years) were treated for middle third humeral shaft fracture by anterolateral approach and internal fixation using AO/DCP or LCP plates that was positioned on anteromedial humeral surface in 141 patients (33.57%) and on anterolateral humeral surface in 279 patients (66.43%). RESULTS: None of the patients who had osteosynthesis by using plate on anteromedial humeral sufrace had lesions of the radial nerve. Therefore, χ2 test revealed significantly higher frequency of postsurgical radial nerve injuries in patients who were treated by anterolateral plating than in patients where anteromedial plating was performed (χ2 = 17.51; p< 0.05). Anterolateral plating required longer mean operation time than anteromedial plating and the difference in its duration determined by t-test for independent samples showed statistically significant difference (t= 14.57; p< 0.05). CONCLUSION: An anteromedial plating of humeral shaft fractures through anterolateral approach was determinated to be a simple, safe, effective and also fast surgical treatment and we highly recommend it as operative technique for treating humeral shaft fractures.

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Authors and Affiliations

  1. Department of Traumatology, Clinic for Surgery, University Hospital Center Rijeka, Rijeka, Croatia

    Ivan Kirin & Damir Grebić

  2. Department of Plastic and Reconstructive Surgery, Clinic for Surgery, University Hospital Center Rijeka, Rijeka, Croatia

    Davor Jurišić

  3. Department of Biology and Medical Genetics, School of Medicine, University of Rijeka, Rijeka, Croatia

    Sergej Nadalin

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  1. Ivan Kirin
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  2. Davor Jurišić
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  3. Damir Grebić
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  4. Sergej Nadalin
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Correspondence to Davor Jurišić.

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Kirin, I., Jurišić, D., Grebić, D. et al. The advantages of humeral anteromedial plate osteosynthesis in the middle third shaft fractures. Wien Klin Wochenschr 123, 83–87 (2011). https://doi.org/10.1007/s00508-010-1523-x

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