Anterior approach in humeral plating osteosynthesis

Humeral plating osteosynthesis is controversial, particularly regarding the choice between anterior and lateral approach, data for which in the context of a low-income country are lacking.

The anterior approach is an easy surgical technique, allowing good anatomic reconstruction. We hypothesize that the anterior approach is associated with fewer neurovascular lesions and functional sequelae than the lateral approach.

A retrospective study with assessment update was carried out over a period of 6years 4months from January 2010 to June 2016, with consecutive recruitment in the city of Yaoundé, Cameroon. It consisted in a review of medical records, with physical reassessment on pre-designed and tested data-sheet. Sixty-two osteosyntheses were documented in 60 subjects operated on for humeral fracture or non-union. The following variables were studied: sociodemographic data, fracture profile, clinical profile, and functional shoulder and elbow results. Data analysis used the Statistical Package for Social Sciences (SPSS), version 23.0. Associations between qualitative variables were assessed on Chi square test, or Fisher test when the expected sample size was less than 5, and between quantitative and qualitative variables on Student t-test for comparison of means; p values≤0.05 were considered statistically significant.

The anterior approach showed better results. Operative time was shorter, at 102.5min on average, for 262cm³ blood loss, versus 141.6min and 330cm³ on the lateral approach, with a significant correlation between the two variables. The incidence of postoperative radial paralysis was significantly higher with the lateral approach (22.6% versus 3.2%; p=0.02), and there were likewise higher rates of postoperative infection (9.7% versus 6.5%), secondary displacement, implant damage, and malunion. Reduction was more often anatomical with the anterior approach (28.1% versus 11%) and cortical fixation was better (83.9% versus 61.3%). Functional shoulder and elbow recovery was nearly normal with both approaches, with superimposable values and no statistically significant difference in (p=0.4).

Cameroon being a low-income country, the anterior approach is of therapeutic and prognostic interest, being easy to perform, with a low rate of postoperative complications and good functional outcome.