Minimally invasive anatomical fixation of distal humeral fractures: Direct reduction through the anterior MIPO distal window.

Abstract

Conventional surgical treatment for distal humeral shaft fractures consists of osteosynthesis through an open posterior approach. This technique requires a wide incision, extensive muscular dissection, and direct handling of the radial nerve, resulting in considerable surgical morbidity. Although the anterior MIPO technique represents a less invasive alternative and avoids these drawbacks, it has traditionally been associated with indirect reduction and relative stability alone. In distal humeral shaft fractures, the distal window of the anterior MIPO approach is located directly above the fracture site, which allows direct reduction manoeuvres. Fragment control through the distal window facilitates reduction and permits the application of absolute stability while preserving a minimally invasive strategy. This technical note describes the integration of these technical innovations together with the use of an inverted PHILOS plate, whose design characteristics enable enhanced distal fixation with a biomechanical profile superior to that of conventional plates. Preliminary results are presented from a case series of Holstein-Lewis-type fractures sustained through a homogeneous torsional mechanism related to arm-wrestling practice.