Sub-muscular plating of the humerus: An emerging technique

Objective

The purpose of the present study was to evaluate percutaneous sub-muscular internal fixation using a locked screw methodology for treatment of diaphyseal humeral fractures.

Methods

Inclusion criteria were multiple extremity fractures, open fractures, neurovascular injuries, additional ipsilateral upper extremity fractures, the inability to obtain a satisfactory closed reduction and isolated fractures with circumstances that prevented effective bracing. Exclusion criteria were immaturity, neoplasm, infection and intra-articular extensions in the same bone. Outcome measures included clinical and radiographic healing, complications, elbow and shoulder symptoms, range of motion (ROM) and Constant-Murley (CM) scores.

Results

Thirty-one patients with 32 fractures were evaluated with a mean follow-up of 16 months (3-38 months). There was radiographic healing in 31 out of the 32 fractures; the non-union was revised to open plating at 6 months and healed uneventfully. Hardware complications included two construct disengagements; one patient was revised and healed, and the other achieved union with bracing. Neurovascular complications included one preoperative nerve palsy that recovered by 3 months, two partial to complete postoperative nerve palsies that recovered by 6 months, and one intact-to-complete nerve palsy due to a bone fragment that required decompression with full recovery by 3 weeks. All patients had functional ROM with a mean CM score of 88. There were no elbow complaints and minor shoulder dysfunction occurred in two patients with ipsilateral shoulder injuries. The rate of neurovascular complications was comparable to open plating techniques and all patients had full recovery.

Conclusion

We feel sub-muscular anterior plating of the humerus using locking screw technology is a viable and useful method for diaphyseal humeral fractures.