Minimally Invasive Plating Osteosynthesis Technique versus Anterolateral Approach for Fixation of Humeral Mid-Shaft Fractures (Systematic Review - Meta-Anaylsis)

Abstract

ractures of the humeral shaft comprise 5-7% of all fractures. Incidence rates reveal a bimodal distribution in which there is one small peak during third decade of life, followed by a larger spike during the seventh decade of life. Various methods are used to treat mid-distal third humeral shaft fractures. Most of the fractures can be effectively treated conservatively. Operative intervention is indicated in special circumstances including (1) failure of closed reduction, (2) intra-articular extension of fractures, (3) neurovascular compromises, (4) associated ipsilateral forearm and elbow fractures, (5) segmental fractures, (6) pathological fractures, (7) open fractures, (8) fractures in polytraumatised patients, (9) bilateral humeral shaft fractures, (10) periprosthetic fractures and (11) transverse or short oblique fractures. There are several surgical approaches to the humeral shaft, and although they have their own unique advantages and disadvantages, the choice is often guided by fracture location: mid-shaft to more distal fractures are typically approached posteriorly or laterally, whereas the anterior and anterolateral approaches are favored for proximal one-third to mid-shaft fractures. One of the main advantages of an anterolateral approach is the possibility for an Extensile exposure, as the approach can be extended both proximally and distally. The anterolateral approach has also been shown to result in lower rates of iatrogenic radial nerve palsy (4%) compared with lateral (20%) and posterior approaches (11%) while also allowing for supine positioning in polytrauma patients.