Efficacy of the MIPO approach combined with inverted Philos plate fixation in the treatment of AO/OTA type 12B distal humeral shaft fractures

Objectives: To investigate the clinical efficacy of anterior anterior minimally invasive plate osteosynthesis (MIPO) approach combined with inverted proximal humeral internal locking system (Philos) plate in the treatment of distal humeral shaft fractures (DHSFs). Methods: The clinical data of 72 patients with AO/OTA type B DHSFs in our hospital from August 2023 to July 2024 were retrospectively analyzed. 35 patients underwent internal fixation via the anterior MIPO approach combined with inverted Philos plate (MIPO group), while 37 patients received internal fixation through the posterior approach using a posterolateral anatomical locking plate (control group). The length of hospital stay, incision length, operation time, intraoperative blood loss, modified radiological union scale for tibia at each follow-up point were observed and followed up. mRUST), Constant Murley shoulder score (Constant score), Mayo elbow performance Score (MEPS), the short-from-36 health survey (SF-36), numerical rating scale (NRS) of elbow joint, callus formation time, fracture healing time, and related complications were compared to evaluate the therapeutic effect. Results: Compared with the control group, patients in the MIPO group had shorter postoperative hospital stay, less perioperative blood loss, shorter surgical incision, shorter time for callus formation and complete fracture healing, and higher mRUST scores at 3 and 6 months after surgery ( P < 0.05). The Constant score, MEPS score and SF-36 score in the MIPO group were higher than those in the control group at 1, 3 and 6 months after surgery ( P < 0.05), but there was no difference between the two groups at 12 months after surgery. The NRS scores of the elbow joint were lower in the MIPO group at 1 month after surgery ( P < 0.05), but there was no significant difference between the two groups at 1, 3 and 6 months. There was no significant difference between the two groups in terms of complications ( P ＞0.05). Conclusions: This study confirmed that the MIPO approach combined with inverted Philos plate fixation is an effective method for internal fixation of type 12B DHSFs. It shortens postoperative hospital stay and promotes fracture healing without increasing operation time or intraoperative blood loss. Lower NRS score in the early stage helps patients to participate in functional exercise early and reduce the incidence of elbow stiffness, making this approach worthy of clinical application.