The  role of minimally invasive plate osteosynthesis (MIPO) technique for treating 3- and 4-part proximal humerus fractures in the elderly – a case study: MIPO for elderly proximal humerus fractures

Dario Attala; Matteo Primavera; Arianna Di Marcantonio; Loris Broccolo; Francesco Pio Oliverio; Carmine Zoccali; Jacopo Baldi; Roberto Biagini

doi:10.23750/abm.v92i4.9985

The role of minimally invasive plate osteosynthesis (MIPO) technique for treating 3- and 4-part proximal humerus fractures in the elderly – a case study

MIPO for elderly proximal humerus fractures

Authors

Dario Attala Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Matteo Primavera Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Arianna Di Marcantonio Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Loris Broccolo Department of Orthopaedic and Traumatology, Ospedale Civile di Crotone, Via Bologna, 88900 Crotone, Italy.
Francesco Pio Oliverio Department of Orthopaedic and Traumatology, Ospedale Civile di Crotone, Via Bologna, 88900 Crotone, Italy
Carmine Zoccali Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Jacopo Baldi Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
Roberto Biagini Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.

DOI: https://doi.org/10.23750/abm.v92i4.9985

Keywords:

minimally invasive plate osteosynthesis, proximal humeral fracture, elderly population, medial hinge

Abstract

Background and aim of the work

Proximal humeral fractures incidence in the elderly population is increasing. Treatment management is complicated by fracture complexity and patients' comorbidities. The aim of our prospective study is the outcome evaluation of the role of minimally invasive plate osteosynthesis (MIPO) for elderly patients with a 3- or 4-parts proximal humeral fractures having an intact medial wall.

Methods

We included n=42 unilateral 3- and 4-parts proximal humeral fractures treated with MIPO: 20 4-part fractures and 22 were 3-parts fractures were included. 17 patients identified as male and 25 as female (mean age 84yo). A trans-deltoid approach has been used with minimal surgical exposure and tissue damage to preserve the local tissue for early shoulder mobilization.

Results

At follow-up, the DASH recorded mean value was 72, while the Constant mean score was 68. Complications have been recorded in 23,8% of patients with 4-parts fractures having the highest complication frequency. Mean shoulder joint ROM was recorded: anterior elevation 75°, lateral elevation 80°, abduction 90°, intra-rotation 50°, extra-rotation 25°. The following factors were identified influencing the outcome: >8mm calcar fragment, head valgus impaction and periosteal medial hinge preservation.

Conclusions

The increase in population longevity matches the increase in complex humeral fracture frequency. We strongly for management consensus for proximal humerus fracture, in a similar way as for neck femoral fractures. MIPO is excellent in reducing soft tissue damage and complications for elderly patients with limited functional demand.

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