From all of the fractures, the humerus shaft fracture accounts for only 1 percent. With the help of the functional bracing, most of these fractures can be treated conservatively with satisfactory results. If we talk about the humerus, it is not a weight-bearing bone and the shortening is tolerable while the misalignments can be compensated with the elbow and shoulder joints. If in case it is not possible to accept the alignment then with the help of the internal fixation the treatments can be done with internal fixation. There are various types of methods that are available for the case of fixation like intramedullary nails, plate fixation, and external fixation.
The method can be chosen based on the location and configuration of the fracture, condition of soft tissues, availability of resources and facilities, bone quality, experience, and skills of the surgical team and canal diameter. While on the other hand the external fixation is majorly reserved for the closed injuries and open fractures of the severe soft tissues, intramedullary nailing, and plating which can be used in the case of the humeral shaft fractures. With the help of the small incursions, it is possible to go through the locked intramedullary nailing and it also results in the trauma of soft tissues.
On the other hand, the bone plate fixation is one of the demanding techniques which require soft tissue dissection and the extensive exposure, from this it can also provide stable fixation. The MIPO technique can be introduced for minimizing or avoiding the disadvantages of open plating like excessive soft tissue stripping and the devascularization. In the case of the fracture of the humeral shaft, the problem with the MIPO technique in the presence of the brachial vessels and the major nerves can lead to serious consequences if injured. On the other hand, it has been shown by the anatomical studies that humerus is having a safe zone that is not crossed by any kind of the major vessel or nerve and is suitable for performing the MIPO process. This safe zone lies below the humeral shaft anterior surface deep down the brachialis muscles.
Indications and contraindications for MIPO
Most of the closed fractures of the humeral shaft the MIPO can be considered. As per the principle of the radial nerve and bridge plating the applied plate can not be identified.
Few good indications for the MIPO are as follows;
· Segmental fractures
· Open growth plates
· Comminuted fractures
· Small Medullary canals
· Fractures extending to the distal or proximal shaft
· Deformed shaft (malunions)
In the case of the humeral shawl fracture, the exact contraindication is the presence of radial nerve palsy in MIPO as during the procedure of MIPO the radial nerve is not identified or exposed at the time of MIPO procedure.
There are certain situations in which the MIPO should not be used like;
Severe tissue loss without coverage of the exposed bone
Delayed reconstruction (like the requirement of the bone grafting)
Delayed surgery with the shortening
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