Comparative Efficacy of Anterior MIPO With PHILOS Versus Posterior ORIF With EA-LCP in Distal-Third Humerus Fractures: A Randomized Controlled Trial.

OBJECTIVES

To compare anterior minimally invasive plate osteosynthesis (MIPO) using the proximal humerus internal locking system in an upside-down reverse configuration with conventional posterior open reduction and internal fixation (ORIF) using extra-articular locking compression plate for the treatment of extra-articular distal-third humeral shaft fractures.

DESIGN

Prospective randomized controlled trial.

SETTING

Single Level 1 trauma center (New Delhi, India).

PATIENT SELECTION CRITERIA: Adult patients aged 18-55 years with extra-articular distal-third humeral shaft fractures (AO/OTA types 12A-C) presenting within 2 weeks of injury were randomized to undergo anterior MIPO or posterior ORIF.

OUTCOME MEASURES AND COMPARISONS: Radiological union, functional outcomes (Mayo Elbow Performance Score, University of California-Los Angeles shoulder rating scale), and elbow range-of-motion were assessed and compared at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Operative time, intraoperative blood loss, radiation exposure, postoperative pain (visual analog scale scores) and complications were also compared.

RESULTS

Thirty patients were included (anterior MIPO, n = 14; posterior ORIF, n = 16). The mean age was 27.9 years (range 18-55) in the MIPO group and 29.8 years (range 19-48) in the ORIF group, P = 0.598. There were 11 men and 3 women in the MIPO group and 11 men and 5 women in the ORIF group, P = 0.68. The mean time to radiological union was shorter in the MIPO group (16.3 ± 1.3 weeks) compared with the ORIF group (18.1 ± 1.2 weeks, P = 0.001). Operative time was shorter in the MIPO group (78.9 ± 24.4 minutes vs. 112.6 ± 42.0 minutes, P = 0.013), intraoperative blood loss was lower (182.1 ± 137.4 mL vs. 328.1 ± 96.8 mL, P = 0.002), and immediate postoperative pain on day 2 was lower (visual analog scale, 7 ± 0.5 vs. 8 ± 0.6, P < 0.001). Functional outcomes showed no statistically significant differences between groups at 6 months (Mayo Elbow Performance Score: 100 vs. 100 P = 1.000; University of California-Los Angeles: 33.8 ± 0.3 vs. 33.7 ± 0.4, P = 0.636), with no statistically significant difference in elbow range-of-motion (137.8 ± 2.5 degrees vs. 135.4 ± 3.0 degrees, P = 0.192). Radiation exposure was higher in the MIPO group (1.5 ± 1.0 mGy vs. 0.3 ± 0.5 mGy, P = 0.003). Postoperative radial nerve palsy occurred in one patient in the MIPO group and three in the ORIF group, with complete recovery in all cases. Nonunion occurred in one patient in each group, both of whom required revision surgery.

CONCLUSIONS

Anterior MIPO using a reverse proximal humerus internal locking system was associated with shorter time to radiological union, lower intraoperative morbidity, and no statistically significant differences in functional outcomes compared with posterior ORIF for patients with extra-articular distal humerus fractures. It was a viable and effective alternative for managing distal third humeral shaft fractures.