Comparison analysis of using three methods for humeral shaft fracture osteosynthesis

Maiorov B.A., Belen’kii I.G., Kochish A.I.

Abstract


Introduction
The tactics of surgical treatment of patients with humeral shaft fractures have beenactively discussed in special scientific literature. The development of new osteosynthesis methods requires their careful comparative evaluation.
Purpose
To compare the treatment results in the three comparable clinical groups of patients with fractures of the humeral diaphysis in its upper and middle thirds after using a minimally invasive osteosynthesis with a helical plate (MIHPO), locked intramedullary osteosynthesis (LIO) and conventional plating osteosynthesis (CPO).
Materials and methods
92 patients with fractures of the humeral diaphysis in its upper and middle thirds were divided into three groups, comparable in number, sex, age, mechanism of injury, location and nature of fractures, according to the osteosynthesis performed: MIHPO (33 patients), LIO (33 Patient) and CPO (26 patients). Terms prior to surgery, intervention time, image intensifier time (IIT), restoration of the humerus anatomy, functional results using DASH and Constant systems, and complications were compared. Control examinations were performed at 1, 6, 12, 18 and 24 weeks after the operation. Clinical, radiographic and statistical methods of study were used.
Results
Duration of the operation in all three groups did not differ significantly. The IIT was significantly less (p less 0.001) in the MIHPO group when compared to LIO. The lowest residual angulation and translation after the osteosynthesis was observed in the CPO group while in MIHPO and LIO groups these findings were not significantly different. The dynamics of restoring the functions of the damaged limb on the DASH and Constant scales did not differ significantly in three groups at all time-points of follow-ups. After 24 weeks, fracture consolidation was noted in all the patients in the MIHPO and CPO groups and in 31 (91.7 %) patients in the LIO group. Six events (18 %) of complications of two types were observed in four patients of MIHPO group (12 %). Ten patients in LIO group (30 %) had 15 complications (45 %) of 6 kinds and 9 complications (35 %) of three kinds were noted in eight CPO patients (30 %).
Conclusion
The MIHPO method is safe and effective. Its results are comparable with the techniques of LIO and CPO in frequency and timing, functional results. However, it results in a lower incidence of complications. Therefore, it can be recommended for a wider application on the appropriate indications.

Keywords


humerus, diaphysis, fracture, minimally invasive plating osteosynthesis, helical plate

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