Effect of MIPO combined with locking compression plate fixation on shoulder and elbow joint function and bone metabolic activity in adult patients with middle humeral shaft fracture.

OBJECTIVE: To analyze the effect of minimally invasive percutaneous osteosynthesis (MIPO) combined with locking compression plate fixation on middle humeral shaft fracture in adults.

METHODS: The clinical data of 88 adult patients with middle humeral shaft fracture treated in Xiang'an Hospital from August 2019 to August 2021 were retrospectively analyzed. According to different surgical methods, they were assigned into an anterograde group (treated with anterograde interlocking intramedullary nail fixation, N=42) and a joint group (treated with MIPO technique combined with locking compression plate fixation, N=46 cases). The perioperative indexes and complications were compared between the two groups. The changes of Constant-Murley shoulder joint function score, Mayo elbow joint function score, bone metabolic activity indexes [collagen hydroxyl terminal peptide (CTX), type I procollagen amino acid terminal peptide (PICP), osteoprotegerin (OPG), and osteocalcin (BGP)], and bone quality indexes [bone trabecular spacing (Tb.Sp), bone volume fraction (BV/TV), bone elastic stress (ES), bone trabecula number (Tb.N), and volume organic matter content (VOC)] were observed before and after the operation for 3 months.

RESULTS: The fracture healing time and postoperative hospitalization time in the joint group were shorter than those in the anterograde group. The intraoperative blood loss was less than that in the anterograde group (P<0.05). Three months after the operation, the scores of the Constant-Murley and Mayo, Tb.N, VOC, and ES in the joint group were higher than those in the anterograde group. The Tb.Sp and BV/TV were lower than those in the anterograde group (P<0.05). The serum CTX level in the joint group was lower than that in the anterograde group. The levels of PICP, OPG, and BGP were higher than those in the anterograde group (P<0.05). There was no significant difference in the total incidence of complications between the joint group and the anterograde group (P>0.05).

CONCLUSION: MIPO technique combined with locking compression plate fixation can promote the healing of middle humeral shaft fracture in adults, improve the function of the shoulder joint and the elbow joint, regulate the activity of bone metabolism, and improve bone quality, without significant increase in complications.