Prospective study of clinical, radiological and functional outcome of anterior bridge plating for shaft of humerus fracture

Abhishek Kumar, Rahul Bade


Background: Shaft of humerus (SOH) fracture has been conventionally treated with either open reduction internal fixation with plate osteosynthesis or immobilization as conservative treatment. Intramedullary interlocking nailing (IMIL) and anterior bridge plating (ABP) are both newer modalities of internal fixation for SOH fracture. Rotator cuff irritation is a known complication of IMIL nailing of the humerus. Here, we present clinical, radiological, and functional outcome of SOH fracture fixation by ABP using a minimally invasive method.

Methods: Thirty patients with SOH fracture were treated surgically via an anterior minimally invasive plate osteosynthesis (MIPO) approach with ABP. There were 21 male and 9 female patients, and the average age was 38.6±10.45 years. The mechanism of injury was road traffic accidents (60%) and ground level fall (40%). Functional assessments were obtained with University of California at Los Angeles (UCLA) score and mayo elbow performance index (MEPI) during the follow-up period.

Results: At the end of 6 months follow-up, 29 (96.7%) patients had excellent to good UCLA and MEPI scores. Varus/valgus angulation was reported in 4 (13.3%) patients. Two patients (6.7%) had radial nerve neuropraxia and delayed union, while 1 (3.3%) patient had screw back-out or loosening. The mean duration of radiation exposure was 178±41.2 seconds. ABP for SOH fractures is a safe and effective treatment modality.

Conclusions: This treatment protocol produces high rates of union, excellent functional recovery, and minimal biological disruption.


Shaft, Humerus, Fracture, ABP, Anterior bridge plating

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Emmett JE, Breck LW. A review and analysis of 11,000 fractures seen in a private practice of orthopaedic surgery, 1937–1956. JBJS. 1958;40(5):1169-75.

Schemitsch EH, Bhandari M, Talbot M. Fractures of the humeral shaft. In: Skeletal Trauma: Basic Science, Management and Reconstruction, 4th ed. Philadelphia, PA: Saunders. 2008;2:1593-4.

Rose SH, Melton JL, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clini Orthop Rel Res. 1982;168:24-30.

Brinker MR, O’Connor DP. The incidence of fractures and dislocations referred for orthopaedic services in a capitated population. JBJS. 2004;86:A(2):290-7.

Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus: an epidemiological study of 401 fractures. JBJS Br. 2006;88(11):1469-73.

Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft of the humerus. JBJS. 1077;59:596-601.

Balfour GW, Marrero CE. Fracture brace for the treatment of humerus shaft fractures caused by gunshot wound. Orthop Clin N Am. 1995;26(1):55-63.

Rosenberg N, Soudry M. Shoulder impairment following treatment of diaphysial fractures of humerus by functional brace. Arch Orthop Trauma Surg. 2006;126(7):437-40.

Denard A Jr, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA. Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopaedics. 2010;11(8):33.

Wallny T, Westermann K, Sagebiel C, Reimer M, Wagne UA. Functional treatment of humeral shaft fractures: indications and results. J Orthop Trauma. 1997;11(4):283-7.

Iwegbu G. Principles and Management of Acute Orthopaedic Trauma. 3rd ed. Bloomington: Author House. 2015.

Baumgaertel F, Buhl M, Rahn BA. Fracture healing in biological plate osteosynthesis. Injury. 1998;29(3):3-6.

Dickson KF, Munz JW. Locked plating: Biomechanics and biology. Tech Orthop. 2007;22:4.

Wagner W, Frenk A, Frigg R. Locked plating: Biomechanics and biology and locked plating: Clinical indications. Tech Orthop. 2007;22:4.

Greiwe R. Proximal humerus fractures: Percutaneous fixation, proximal humeral nailing, and open reduction and internal fixation. In: Greiwe RM, editor. Shoulder and Elbow Trauma and its Complications. Cambridge: Woodhead Publishing; 2015;1:83-112.

Shetty MS, Kumar MA, Sujay K, Kini AR, Kanthi KG. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures. Indian J Orthop. 2011;45(6):520-6.

Matsunaga FT, Tamaoki MJ, Matsumoto MH, dos Santos JB, Faloppa F, Belloti JC. Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial. Trials. 2013;14:246.

Sharma J, Jain A, Jain PG, Upadhyaya P. Anterior bridge plating with mini incision MIPO technique for humerus diaphyseal fractures. Indian J Orthop Surg. 2015;1:171-5.

Mahajan AS, Kim YG, Kim JH, D'sa P, Lakhani A, Ok HS. Study in Athletes and Manual Laborers. Clin Orthop Surg. 2016;8(4):358-66.

Vegad T, Suthar D. Follow up assessment of patients with humeral bridge plate technique with two year period. Int J Res Orthop. 2017;3:867-70.

Ibrahim M, Rathod VH. A clinical study of minimal invasive anterior bridge plating for humerus shaft fractures. Int J Orthop Sci. 2018;4:1-5.

An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop. 2010;34(1):131-5.

Malhan S, Thomas S, Srivastav S, Agarwal S, Mittal V, Nadkarni B, Gulati D. Minimally invasive plate osteosynthesis using a locking compression plate for diaphyseal humeral fractures. J Orthop Surg (Hong Kong). 2012;20(3):292-6.

Vilaça PR Jr, Uezumi MK. Anterior minimally invasive bridge-plate technique for treatment of humeral shaft nonunion. J Orthop Traumatol. 2012;13(4):211-6.

Uhthoff HK, Poitras P, Backman DS. Internal plate fixation of fractures: short history and recent developments. J Orthop Sci. 2006;11(2):118-26.

Mahajan AS, Kim YG, Kim JH, D'sa P, Lakhani A, Ok HS. Is anterior bridge plating for mid-shaft humeral fractures a suitable option for patients predominantly involved in overhead activities? A functional outcome study in athletes and manual laborers. Clin Orthop Surg. 2016;8(4)358-66.

Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop. 2010;34(4):571-6.