A 26-year-old man was involved in a motorcycle accident and sustained a multifragmentary fracture of the right humeral shaft without radial nerve injury. This was the only injury that he sustained in the accident.
Indication for MIPO
In multifragmentary humeral shaft fractures direct reduction by conventional open plating results in extensive soft-tissue dissection with devascularization of the fracture area, and causes complications, eg, disturbed bone healing and implant failure. In case of open reduction of comminuted fractures primary bone graft may be indicated to prevent such complications. MIPO in this case is recommended.
a–b AP (a) and lateral (b) x-rays of the right humerus show a wedge fracture with small comminution.
Preoperative planning
a–b Indirect reduction is planned using an external fixator. A Schanz screw is inserted monocortically perpendicular to the shaft axis on the lateral aspect of the greater tuberosity. Another Schanz screw is placed on the lateral side of the distal humerus above the olecranon fossa and parallel to the elbow joint.c–d These two Schanz screws are then connected by the external fixator tube while reducing the fracture under image intensification.e–f Reduction is maintained by an external fixator frame, and plating is performed through the submuscular tunnel by the anterior approach.
Only gold members can continue reading. Log In or Register to continue
Humerus, proximal
Humerus, shaft—introduction
Femur, proximal: extraarticular fracture, trochanteric area pertrochanteric simple—31-A1
Femur, distal: extraarticular simple fracture—33-A1.2
Extraarticular, bifocal closed fracture—42-A1, and articular trimalleolar ankle fracture—44-C2.3 (closed transverse fracture of the medial malleolus, lateral malleolus, and posterior malleolus)
Tibia and fibula, distal—introduction
