Comparison between Intramedullary Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis in Treatment of Humeral Shaft Fractures

Objective: To compare the efficacy of intramedullary nailing (IMN) and minimally invasive percutaneous plate osteosynthesis (MIPO) in treatment of humeral shaft fractures. Study Design: Descriptive study. Place and Duration of Study: Department of Orthopedics, Zhejiang Hospital, China, during March 2010 to December 2016. Methodology: The study included patients with humeral shaft fractures who received surgery by IMN or MIPO. The intraoperative outcomes including operation time, bleeding volume, and the postoperative outcomes were also recorded. The Constant-Murley scores were used for assessment of function of shoulder joint and Mayo score was used for measurement of elbow joint function. Results: Among a total of 436 patients with humeral shaft fractures, 204 cases received MIPO and 232 cases received IMN. The follow-up duration ranged from 16-36 months with a mean duration of 25.8 +/- 6.1 months. The mean operation time, mean bleeding volume, mean hospitalisation time and mean healing time showed no significant difference between MIPO and IMN groups. No significant difference was observed in Mayo scores, but the Constant-Murley scores of MIPO group was significantly higher that the IMN group. Fracture nonunion was observed for 15 (6.5%) cases in IMN group; however, only 1 (0.5%) case was found to be nonunion in MIPO group. Meanwhile, 9 (4.4%) cases showed radial nerve injury in the MIPO group, with no significant difference compared to the IMN group of 15 (6.5%) cases. Conclusion: Both the two methods were effective; however, MIPO method might be better for recovery of shoulder function and might reduce the nonunion rate.