Comparison of minimally invasive osteosynthesis and open reduction and internal fixation of proximal humerus fractures
https://doi.org/10.17238/2226-2016-2023-4-86-96
Abstract
About 5-6 % of all fractures occur in damage to the proximal humerus. Treatment depends on many factors, including the degree of fracture displacement, the patient's activity level, associated injuries and diseases, age, fracture type, and bone quality. The most acceptable surgical options are open reduction and internal fixation (ORIF), minimal invasive plate osteosynthesis (MIPO).
Purpose of the study: to compare the results of studies of minimally invasive and open techniques of osteosynthesis of the proximal humerus.
Materials and methods: PubMed, EMBASE, Cochrane Library, ScienceDirect, WebOfScience were searched to find all relevant studies in the period 2015-2023. In addition, the literature lists of relevant studies were searched. There were no linguistic restrictions.
Results: Selected 24 studies by design were retrospective studies, 9 articles were devoted only to the MIPO technique, 1 clinical case was bilateral ORIF. A total of 1698 patients were analyzed in the studies. The mean follow-up period was 25.2 months. The mean age of the patients was 61.3 ± 8 years. The most common complications were avascular necrosis of the humeral head, subacromial impingement, screw perforation, infection of the postoperative wound area, varus collapse (loss of medial support), nonunion, and axillary nerve injury. Compared to ORIF, MIPO has advantages in terms of operative time, tuberculum major reposition, blood loss, postoperative pain, early postoperative shoulder function, and cosmetic outcome. MIPO requires a longer intraoperative x-ray time. MIPO requires a longer intraoperative x-ray time and is not indicated for multifragmentary fractures according to few articles. There was no significant difference in complication rates between these methods.
Conclusion: Until now, ORIF is the standard osteosynthesis technique for complex multifragmentary fractures. However, it does not differ significantly from the minimally invasive technique. The MIPO technique shows itself to be promising and requires an expansion of indications for use.
Keywords
Supporting agencies: The study had no sponsorship
About the Authors
A. O. Tuturov
Clinical Hospital named after S.S. Yudin
Russian Federation
Russian Federation
Alexander Olegovich Tuturov, doctor
Department of Hand surgery and Reconstructive microsurgery
115446; Kolomenskiy p, 4; Moscow
A. S. Petrosyan
Clinical Hospital № 17
Russian Federation
Russian Federation
Armen Sergeevich Petrosyan, Chief of department
orthopedics department
119620; Volinskaya str., 7; Moscow
M. A. Panin
Clinical Hospital № 17; Peoples' Friendship University of Russia
Russian Federation
Russian Federation
Mikhail Aleksandrovich Panin, doctor, PhD, associate Professor
Orthopedic Department; Department of traumatology and orthopedics
119620; Volinskaya str., 7; 117198; Mikluho-Maklaya str., 6; Moscow
K. A. Egiazaryan
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Karen Albertovich Egiazaryan, MD, PhD, professor, chief of chair
chair of traumatology, orthopedics and military surgery
117997; Moscow
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For citations:
Tuturov A.O., Petrosyan A.S., Panin M.A., Egiazaryan K.A. Comparison of minimally invasive osteosynthesis and open reduction and internal fixation of proximal humerus fractures. Department of Traumatology and Orthopaedics. 2023;(4):86-96. (In Russ.) https://doi.org/10.17238/2226-2016-2023-4-86-96
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