Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application. 2023

Valeska Hofmann, and Julian Diepold, and Mohamed Moursy, and Marco T Birke, and Christian Deininger, and Florian Wichlas
Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG Trauma Center Tübingen, Tübingen, Germany. vhofmann@nolimitsurgery.com.

BACKGROUND The indication for minimally invasive plate osteosynthesis (MIPO) may include articular fractures depending on the fracture pattern. The goal of this study was to evaluate the feasibility of the MIPO technique for extra- and intra-articular distal humeral fractures. METHODS The feasibility of the MIPO technique was assessed on 8 cadaveric elbows and 2 clinical cases. The four surgical approaches tested included a 20-mm ulnar incision, a 20-mm dorsoradial incision, and two incisions for olecranon osteotomy (A and B). Surgical incision A was 40 mm on the osteotomy level of the olecranon, and surgical incision B was an extension of the radial incision toward the osteotomy of the olecranon (80 mm). The four approaches were tested on 4 extra-articular (AO 13 A3) fractures and 4 intra-articular (AO 13 C3) fractures. RESULTS Reduction and plate fixation of all distal humeral fractures (8 cadaveric) with and without osteotomy was feasible. However, when using approach B, the soft tissue tension is reduced due to the wider incision. Nevertheless, both approaches A and B showed the same adequate intra-articular fracture control and reduction. CONCLUSIONS The MIPO technique for reduction and plate fixation in distal humeral fractures is feasible. METHODS As a feasibility study, this study cannot be clearly classified into a level of evidence. It corresponds most closely to level IV.

UI MeSH Term Description Entries
D001860 Bone Plates Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999) Bone Plate,Plate, Bone,Plates, Bone
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006810 Humeral Fractures Fractures of the HUMERUS. Humeri Fractures,Humerus Fractures,Fracture, Humeral,Fracture, Humeri,Fracture, Humerus,Humeral Fracture,Humeri Fracture,Humerus Fracture
D000072836 Surgical Wound An incision made during a surgical procedure. Surgical Incision,Incision, Surgical,Incisions, Surgical,Surgical Incisions,Surgical Wounds,Wound, Surgical,Wounds, Surgical
D000092483 Humeral Fractures, Distal Fractures of the distal HUMERUS at the ELBOW JOINT. Capitellum Humeri Fracture,Capitellum Humerus Fracture,Distal Humeral Fractures,Distal Humerus Fractures,Hahn-Steinthal Fracture,Humeral Capitellar Fractures,Humeral Trochlear Fractures,Intercondylar Humeral Fractures,Intercondylar Humerus Fractures,Kocher-Lorenz Fracture,Lateral Condylar Fracture of Humerus,Lateral Condylar Fractures of Humerus,Lateral Condyle Fracture of Humerus,Lateral Condyle Fractures of Humerus,Lateral Epicondylar Fracture of Humerus,Lateral Epicondylar Fractures of Humerus,Lateral Epicondyle Fracture of Humerus,Lateral Epicondyle Fractures of Humerus,Lateral Epicondyle Fractures of the Elbow,Lateral Humeral Condyle Fractures,Supracondylar Distal Humeral Fracture,Supracondylar Distal Humeral Fractures,Supracondylar Distal Humerus Fracture,Supracondylar Distal Humerus Fractures,Trochlear Fractures, Humerus,Capitellar Fracture, Humeral,Capitellum Humeri Fractures,Capitellum Humerus Fractures,Distal Humeral Fracture,Distal Humerus Fracture,Fracture, Capitellum Humeri,Fracture, Capitellum Humerus,Fracture, Distal Humeral,Fracture, Distal Humerus,Fracture, Hahn-Steinthal,Fracture, Humeral Capitellar,Fracture, Humeral Trochlear,Fracture, Humerus Trochlear,Fracture, Intercondylar Humeral,Fracture, Intercondylar Humerus,Fracture, Kocher-Lorenz,Fractures, Humeral Capitellar,Fractures, Humeral Trochlear,Hahn Steinthal Fracture,Humeral Capitellar Fracture,Humeral Fracture, Distal,Humeral Fracture, Intercondylar,Humeral Trochlear Fracture,Humeri Fracture, Capitellum,Humerus Fracture, Capitellum,Humerus Fracture, Distal,Humerus Fracture, Intercondylar,Humerus Trochlear Fracture,Humerus Trochlear Fractures,Intercondylar Humeral Fracture,Intercondylar Humerus Fracture,Kocher Lorenz Fracture,Trochlear Fracture, Humeral,Trochlear Fracture, Humerus
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D050723 Fractures, Bone Breaks in bones. Bone Fractures,Broken Bones,Spiral Fractures,Torsion Fractures,Bone Fracture,Bone, Broken,Bones, Broken,Broken Bone,Fracture, Bone,Fracture, Spiral,Fracture, Torsion,Fractures, Spiral,Fractures, Torsion,Spiral Fracture,Torsion Fracture
D057072 Intra-Articular Fractures Fractures of the articular surface of a bone. Intraarticular Fractures,Fracture, Intra-Articular,Fracture, Intraarticular,Fractures, Intra-Articular,Fractures, Intraarticular,Intra Articular Fractures,Intra-Articular Fracture,Intraarticular Fracture

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