The optimal management of distal humeral shaft fractures is technically challenging and controversial. One approach to surgical treatment is fixation with a reconstruction plate:
A lateral approach is generally used for distal 1/3 fractures.
However, the middle and distal third of the humerus is internally rotated 20° to 30°, so the plate needs to be shaped when placed in the anterolateral position so that the plate can adhere better.
Minimally invasive plate internal fixation (MIPO) preserves the blood supply to the fracture area and avoids complications after nailing. MIPO of the humeral shaft can be performed through anterior, posterior or lateral approaches. However, a limitation of this method is that when there is only a small amount of bone fixation for distal humeral fractures, the fixation is unstable. The prerequisite for MIPO via the anterior approach is that the distal bone fragment of the coronal fossa is at least 6 cm intact.
The Proximal Humeral Internal Locking System (PHILOS) plate is a commonly used implant for proximal humeral fixation.
Because the shape of the plate matches the distal humeral metaphyseal process (Figure 1c) and uses multidirectional locking screws (Figure 1d), this implant can be used as an alternative option for fixation of distal humeral shaft fractures.
Anterior MIPO is a safe and effective method for treating distal humeral shaft fractures.
Surgical method:
The operation starts with a 4-6 cm distal skin incision, which is located 2.5 cm above the antecubital crease. After confirming the lateral edge of the biceps brachii (Figure a below), the biceps brachii is pulled medially to expose the brachialis. The musculocutaneous nerve located on the anteromedial surface of the brachialis is identified. After this, the muscle is divided longitudinally to expose the distal humeral fragment (Figure b below). A proximal skin incision between the medial edge of the deltoid and the lateral edge of the biceps (Figure c below) is made and peeled directly to the anterior crest of the proximal humerus. A bone tunnel is created. The corresponding plate and screw fixation.
Postoperative fluoroscopic images:
Case 1:
Case 2:
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Post time: Jul-25-2024