Nowadays minimally invasive plate osteosynthesis (MIPO) is gaining preference with respect to other treatment modalities for diaphyseal fracture of humerus because biological fixation of fractures with soft tissue and fracture haematoma preservation and near acceptable reduction is becoming a more acceptable entity. MIPO technique shows high rate of union, less risk of infection, reduced risk of iatrogenic radial nerve palsy and decreased blood loss. We have evaluated the radiological and clinical outcomes of fracture shaft of humerus treated with the MIPO technique over a minimum follow up of 1 year.
Materials and Methods: A hospital based prospective study was conducted in the Department of Orthopaedics, Silchar Medical College and Hospital, Assam. 12 adult patients with diaphyseal fracture of humerus admitted in Silchar Medical College and hospital treated with Minimally Invasive Percutaneous Osteosynthesis (MIPO) technique between June 2017 and May 2018 were included in the study. In all cases 4.5mm locking compression plate was applied using MIPO technique and follow up was done monthly with 1st follow up on completion of 2 weeks and thorough clinical and radiological evaluation was done.
Results: Out of 12 patients, the maximum numbers of patients were observed between 31– 40 years, with a mean age of 39.17 years. There was male preponderance (66.67%) in the study group with maximum of the cases due to road traffic accident (66.67%). Left side was most commonly affected (54.16%) with maximum of them being Type A fractures (50%) as per AO/OTA classification. The average time interval between the trauma and surgery was 7.08 days. The minimum operative time was 62 minutes and maximum was 115 minutes with a mean of 98.5 minutes. The mean amount of blood loss was 85.42 ml. Overall, average hospital stay of the studied group was 8.75 days. The mean forward flexion & abduction of the shoulder joint was 155.83°& 119.17° respectively. The mean range of motion of elbow was (2.5° - 126.25°). The mean UCLA shoulder score at last follow up was 33.42 considered as Good/Excellent. The mean MEPS score at last follow up was 92.25 (Excellent). The mean VAS score was 4.67 at last follow up. The mean time for union was at 12.5 weeks. In the study group, 25% (3 cases) had complications. 2 (16.67%) had varus malunion and the remaining 1 (8.33%) had infection.
Conclusion: The fracture of diaphysis of humerus mostly occurs in adults; road traffic accidents and fall are the two most common modes of injury. The primary goal in treatment of this injury is to provide good reduction and immediate stability to achieve early fracture union, allow the quick return of function, and to avoid complications which is achieved by minimally invasive percutaneous plate osteosynthesis (MIPO).