Case-Match Controlled Comparison of Minimally Invasive Plate Osteosynthesis and Open Reduction Internal Fixation for the Stabilization of Humeral Shaft Fractures

Purpose: Compare minimally invasive plate osteosynthesis (MIPO) to open reduction/internal fixation (ORIF) for humeral shaft fractures, to determine which technique minimized complications while optimizing clinical outcomes.

Methods:Retrospective case-match controlled cohort from a tertiary referral trauma centre. All patients with humeral shaft fractures between April 2010 and September 2015 were identified, a total of 123 fractures. Of these, 31 were treated by MIPO and 54 by ORIF. Indications for surgical management included poly-trauma, floating elbow, and failure of non-operative treatment. A case-matched cohort was assembled according to fracture pattern, gender, age, and comorbidities, with a total of 56 patients (28 per group). The pooled complication rate was the primary outcome measure (radial nerve injury, non-union, infection, prominent implants, and re-operation). Radiographic alignment and the DASH Score were secondary outcome measures.

Results:Cumulative complication rates were 3.6% following MIPO and 42.9% after ORIF (P=0.0004). The mean DASH Score following MIPO was 17.0 ± 18.0, and after ORIF was 24.9 ± 19.5, but this difference was not significantly different (p=0.140).The mean coronal plane angulation following MIPO was 1.8^o± 1.3^o, and after ORIF was 1.0^o± 1.2^o (p=0.022). The mean sagittal plane angulation following MIPO was 3.0^o± 2.9^o, and after ORIF was 1.0^o± 1.2^o (p=0.002). These radiographic findings were not considered clinically meaningful.

Conclusions:The cumulative complication rate was 12 times higher following ORIF of humeral shaft fractures compared to MIPO. MIPO achieved nearly equivalent radiographic alignment, with no clinically meaningful differences observed. Although the patient-reported DASH Score was better after MIPO, this difference was not significant. This study demonstrates MIPO of humeral shaft fractures can achieve highly comparable clinical results with a dramatically lower risk of post-operative complications compared to ORIF. It is an attractive treatment option for those patients with humeral shaft fractures unsuitable for non-operative management.