Minimally invasive three-incision technique for humeral fractures of middle and inferior shaft involving the distal end

Objective To assess the minimally invasive three-incision technique used in surgical treatment of humeral fractures of middle and inferior shaft involving the distal end. Methods Six cases of humeral fractures of middle and inferior shaft involving the distal end were surgically treated from 2004 to 2007. A combined medial and lateral elbow incision was made to expose the intra-articular fracture of distal humerus. The articular fragments were reduced and fixed with a cannulated screw. The articular component was then reduced to the metaphyseal part of the distal humerus and fixed with a medially positioned one-third tubular plate. The humeral shaft fracture was closely reduced. A pre-contoured 4.5 mm dynamic compression plate was inserted through a small incision made at the anterior side of the proximal part of the arm and placed proximally on the anterior aspect of the humeral shaft and distally on the anterolateral side of the lateral column of the distal humerus to fulfill the fixation of both the humeral shaft and the articular component. Bone healing time, range of motion (ROM) of the affected elbow and postoperative complications were recorded. Elbow functions were evaluated by the Mayo system. Results The 6 cases were followed up for a mean time of 22. 2 months (range, 13 to 36 months). All the fractures were healed in a mean time of 19 weeks (range, 12 to 24 weeks) . The mean ROM of the elbow was 130. 8° (range, 110° to 140°) . No iatrogenic radial nerve paralysis or hardware failure occurred in this series. By the Mayo evaluation system, the elbow functions were rated as excellent for all in this series. Conclusion The minimally invasive three-incision technique is simple and effective for treatment of humeral fractures of middle and inferior shaft involving the distal end. Key words: Humeral fracture; Fracture fixation, internal; Bone plates