A Prospective Comparative Study of the Outcome of Diaphyseal Humeral Shaft Fractures with Anterior BridgePlating versus Open Reduction Internal Fixation by Dynamic Compression Plating.

Introduction: Plate osteosynthesis has traditionally been the preferred treatment for humeral shaft fractures requiring surgical intervention. However, plating involves an open approach, necessitating careful and meticulous handling of soft tissue. As a result, the anterior bridge plating (ABP) as minimally invasive plate osteosynthesis (MIPO) is emerging as a promising technique for managing humeral shaft fractures.We performed an analysis on both groups (40 patients each), and our primary objectives compared were radiological outcome, functional outcome using UCLA shoulder score Mayo elbow score, time period of union. Our secondary objectives were rate of infection, postoperative radial nerve palsy, surgical time, number of fluoroscopic shoots. Material and Method: Eighty patients with humerus mid-shaft fractures which with inclusion criteria were randomly selected and divided into two groups. Group1(n= 40) patients were treated with MIPPO by ABP and group 2 (n = 40) with open reduction and internal fixation (ORIF). Discussion: Most of the studies which have been done previously on this MIPO technique used Locking compression plate which showed good results, even when compared to intramedullary nailing and conventional plating. Using the Locking compression plate gives us confidence in terms of giving relative stability even in young patients with good bone stock. The unique feature of this study is the even Dynamic compression plate gives us good secure fixation with relative stability causing axial micro-movements at the fracture even in transverse fracture pattern. Results: Eight patients were randomly selected by allotting them alternatively to each procedure, with 40 in each group. Group-1 patients are operated by Anterior Bridge Plating, Group-2 patients are operated by conventional posterior plating using DCP. Male to female ratio was 4:1 and the mean age group was 31-45 years. The most common type of fracture pattern seen was B2 type according to AO classification system. Group-1 (ABP) showed better results in terms of infection, post-operative radial nerve palsy, time period of union, time period of union and functional outcome. Yet, this also few shortcomings like long surgical time period with increased radiation exposure. Conclusion: The MIPPO by ABP technique provides good results comparable to the ORIF method for all types of humeral shaft fractures. While this new technique may promote early union and better functional outcomes by minimising perioperative complications and soft tissue dissection, it also involves a significant amount of radiation exposure.