The clinical outcomes of anterior minimally invasive inverted PHILOS plate fixation for distal humeral shaft fractures.

Abstract

The unique anatomy and biomechanics of the distal humerus make distal humeral shaft fractures a significant challenge in orthopedic surgery. Conventional posterior surgical approaches are associated with risks such as iatrogenic radial nerve injury and increased soft tissue trauma. This study aimed to assess the clinical efficacy of an inverted PHILOS plate using an anterior minimally invasive percutaneous approach for treating distal humeral shaft fractures. We enrolled 32 patients with distal humeral shaft fractures. The surgical technique involved an anterior minimally invasive percutaneous application of an inverted PHILOS plate. Outcome measures included operative time, intraoperative blood loss, incision length, fracture healing time, and functional scores (Constant-Murley and Mayo Elbow Performance Scores). Postoperative complications, including nerve injury and nonunion, were documented. The mean operative time was 1.69 ± 0.66 h, with a median blood loss of 50 ml (IQR: 50-100 ml). The mean incision length was 10.9 ± 1.78 cm, and the mean time to fracture healing was 11.2 ± 3.68 weeks. Functional outcomes were satisfactory, with a mean Constant shoulder score of 92.69 ± 6.6 and a mean Mayo Elbow Performance Score of 91.4 ± 8.04. No instances of iatrogenic nerve injury or nonunion were observed. The anterior minimally invasive percutaneous approach using an inverted PHILOS plate is an effective method for treating distal humeral shaft fractures. This technique minimizes soft tissue damage, reduces the risk of iatrogenic radial nerve injury, and ensures reliable fracture stabilization, thus offering a promising alternative to conventional posterior approaches.