Comparative Analysis of Results of Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) and Intramedullary Nail (IMN) In Humerus Shaft Fracture – A Prospective Study.

ABSTRACT

Background: Treatment of humeral shaft fractures continues to evolve as advances are made in both non-operative and operative management. The encouraging results that have been reported with recent advances in internal fixation techniques and instrumentation. The controversy still exist between plating and intramedullary nailing. MIPO (Minimal invasive plate osteosynthesis) has emerged as a new alternative mode or treatment. In this study, we compare the result of MIPO and intramedullary nailing. Methods: This was an institution based, prospective longitudinal and comparative study. Patients of age of 20 to 60 years (skeletally mature) which required operative intervention in this study. Pathological fractures, segmental fractures, neurovascular injury were excluded. Patients were followed for at least one year. Results: 130 patients were included in this study. Intramedullary nailing was done in 60 patients and MIPO plating done in 70 pts. Demographically, there was no difference between the groups. No statistical difference was found regarding union and complication. There was significant statistical difference of UCLA shoulder score between the groups. But no difference in Mayo elbow performance score. Discussion: This study shows that the MIPPO technique is safe, convenient and effective, since there was a minimal soft tissue injury and no major complications. It does not disturb the fracture hematoma like open plating and thus help in fracture union. There is no injury to the rotator cuff or supraspinatus tendon like intramedullary nailing in MIPO plating. Conclusion: MIPO is a modality which results in a relatively stable fracture construct while preserving a biologic environment that facilitates rapid bone healing without disturbing rotator cuff.