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Anterior minimally invasive plating osteosynthesis technique (MIPO) for humeral shaft fractures: an anatomical study of neuromuscular structures at risk

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate the neuromuscular structures at risk during modified anterior minimally invasive plating osteosynthesis technique (Belangero–Livani) for humeral shaft fractures.

Methods

Eight fresh-frozen human specimens ranging from 38 to 82 years old were used. Specimens were positioned supine with the shoulder in 70° abduction and the forearm in full supination. Anterior minimally invasive plating osteosynthesis technique according to Belangero–Livani technique was performed in each specimen. Under radioscopic control, the plate was introduced in retrograde fashion through the subbrachialis path. Anatomical structures were inspected and different anatomical parameters were measured after dissection at the end of the surgical procedures. Measurements were performed using a high digital caliper. Statistical analysis was performed using the Pearson’s correlation coefficient test. A p value of < 0.05 was used to define statistical significance.

Results

There were no macroscopic lesions of myotendinous or neurovascular structures in any specimen. The mean distance between the radial nerve to the distal lateral end of the plate was 8.63 mm (range 4.14–13.83 mm). The mean total length of the humerus was 328.59 mm. We found a significant direct correlation between the total length of the humerus and both specimen height and weight.

Conclusion

The modified Belangero–Livani anterior MIPO technique for humeral shaft fractures performed in retrograde fashion is safe and useful, without major risk to the soft tissue of the anterior compartment of the arm, including the radial nerve in the lateral intermuscular septum. Intraoperative dissection, avoiding deep lateral retraction on the distal approach, minimizes the risk of radial nerve damage. Strict surgical planning and appreciation for the anatomic landmarks can reduce the risk of damage to neuromuscular structures.

Level of evidence

Level IV; Case series with no comparison group; Treatment study

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Funding

The authors did not receive Grants or outside funding in support of their research for or preparation of this manuscript. Authors and any member of their families did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Author information

Authors and Affiliations

  1. Serviço de Traumato-Ortopedia, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil

    Marcos Giordano

  2. Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil

    Vincenzo Giordano

  3. Clínica São Vicente, Rede D’Or São Luiz, Rio de Janeiro, Brazil

    Vincenzo Giordano

  4. Departamento de Cirurgia, Universidade Federal Fluminense (UFF), Niterói, Brazil

    Vinícius Schott Gameiro

  5. Departamento de Ortopedia, Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP), Campinas, Brazil

    William Belangero & Bruno Livani

  6. Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK

    Peter V. Giannoudis

  7. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover (MHH), Hannover, Germany

    Christian Krettek

Authors
  1. Marcos Giordano
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  2. Vincenzo Giordano
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  3. Vinícius Schott Gameiro
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  4. William Belangero
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  5. Bruno Livani
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  6. Peter V. Giannoudis
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  7. Christian Krettek
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Contributions

MG and VG were involved in conceptualization, data curation, investigation, and visualization. MG, VG, and CK were contributed to formal analysis, project administration, resources, supervision, and validation. VG was involved in writing—original draft. MG, VG, VSG, WB, BL, PVG, and CK were involved in writing—review and editing. Methodology was contributed by MG, VG, WB, CK. Funding acquisition was contributed by no one.

Corresponding author

Correspondence to Vincenzo Giordano.

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Conflict of interest

Vincenzo Giordano has the following disclosures: Zimmer Biomet: paid consultant and unpaid consultant. Peter V. Giannoudis has the following disclosures: Injury: Editorial or governing board. Christian Krettek has the following disclosures: Traumastiftung: Board or committee member; Springer: Publishing royalties, financial or material support; DFG: research support; AO: research support; BMBF: research support; Else Krömer: research support; Traumstiftung: research support. The remaining authors have nothing to disclose.

Ethical approval

The study was performed according to the ethical procedures recommended by the international federation of associations of anatomists (IFAA) and approved by the Institutional Review Board of Klinik für Unfallchirurgie–MHH.

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Giordano, M., Giordano, V., Gameiro, V.S. et al. Anterior minimally invasive plating osteosynthesis technique (MIPO) for humeral shaft fractures: an anatomical study of neuromuscular structures at risk. Eur J Orthop Surg Traumatol 31, 449–458 (2021). https://doi.org/10.1007/s00590-020-02792-2

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  • DOI: https://doi.org/10.1007/s00590-020-02792-2

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