Treatment of middle third humeral shaft fractures: minimal invasive plate osteosynthesis versus expandable nailing

The purpose of this study is to compare the results of middle third humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) with those treated with an expandable nail technique. Thirty-four patients with middle third humeral shaft fractures were retrospectively analyzed and divided into two groups: group A included 15 patients treated by MIPO and group B included 19 patients treated with an expandable intramedullary nail. The operation time, postoperative complications, time to fracture union, the UCLA End-Result score of the shoulder, and Mayo elbow performance index (MEPI) were recorded and compared. The mean operation time in group A was 108.3 ± 28.7 min and 85.0 ± 35.7 min in group B, a difference of 23.3 (27.4%) minutes (P < 0.05). There were no cases of iatrogenic radial nerve palsy or superficial infection in either group. All fractures united. The mean time to fracture union in group A was 16.1 ± 6.0 (8–32)weeks, versus 15.0 ± 2.5 (10–21) weeks in group B (P > 0.05). One case of delayed union was identified in group A. The mean UCLA End-Result score in group A was 34.2 ± 1.1 points (31–35 points)and 31.8 ± 2.6 points (26–35) in group B (t = 3.318 P = 0.002, P < 0.05). All the patients had excellent elbow functions. In surgical treatment of middle third humeral shaft fractures, MIPO appeared to offer advantages in terms of better shoulder and no iatrogenic radial nerve injuries, although technically more difficult and time consuming.