Medial minimally invasive plate osteosynthesis for humeral shaft fractures: a case series.

Minimally invasive plate osteosynthesis (MIPO) is increasingly favored for treating humeral shaft fractures (HSFs). However, conventional MIPO techniques pose challenges in fixing fractures near the fossa olecrani and carry a high risk of iatrogenic radial nerve palsy. This study was aimed to report the clinical outcomes of a series of patients who underwent MIPO through a medial approach for HSFs and describe our treatment algorithm. Patients and Method: This is a study conducted in our university hospital, which is a Level 1 academic trauma center. A retrospective analysis of 21 patients with HSFs who received minimally invasive treatment using plate osteosynthesis through a medial approach over a 5-year period was conducted. The outcomes measured included time for radiographic consolidation, disabilities of the arm, shoulder, and hand score, and complications such as infection, iatrogenic radial nerve injury, loss of reduction or fixation, and nonunion. Results: Twenty-one patients who underwent the procedure were identified. Bone healing was achieved in all patients with an early and aggressive range of motion. There were no cases of infection or iatrogenic radial nerve injury. The mean radiographic fracture union time was 15.76 weeks (range: 8-40 weeks). The mean disabilities of the arm, shoulder, and hand score was 3.29 (range: 0-14.17) at the time of the last follow-up. The mean screw density was 0.43. Conclusion: The proposed algorithm is effective in addressing the challenges of iatrogenic nerve injury and extra-articular distal fixation of HSFs with conventional MIPO techniques.