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Does the operative technique (MIPO vs. ORIF) influence surgical outcomes and complications in proximal humerus
Christiane Barthel1,2, Franziska Rudolph3, Moritz Kraus4,3
1Department of Shoulder and Elbow Surgery, Schulthess Klinik, Lengghalde 2, Zurich, CH-8008, Switzerland. christiane.barthel@kws.ch.
Introduction:
Proximal humerus fractures account for approximately 4-6% of all fractures and are among the most common fractures in the elderly. Surgical treatment is increasingly applied for displaced and unstable fracture patterns. The two most commonly used techniques are open reduction and internal fixation (ORIF) via a deltopectoral approach and minimally invasive plate osteosynthesis (MIPO) using a deltoid-split or anterolateral approach. ORIF allows direct fracture visualization and anatomical reduction but is associated with more extensive surgical exposure. MIPO aims to preserve soft tissues and vascular supply through indirect reduction techniques. This study compares ORIF and MIPO in proximal humerus fractures with regard to surgical parameters, radiographic outcomes, and complications.
Methods:
A retrospective single-center cohort of 392 proximal humerus fractures was analyzed. Seventy-nine patients treated with MIPO were matched to 79 patients treated with ORIF using exact matching for fracture type (Mayo FJD classification) and propensity score matching for age and sex. Primary outcomes included operative time, reduction quality, and complication rates.
Results:
The MIPO group showed significantly shorter operative times (97.3 ± 30.8 min vs. 112.2 ± 34.0 min, p = 0.004). No significant differences were observed in reduction quality or overall complication rates (MIPO 19.0% vs. ORIF 21.5%). However, functional complications and implant malpositioning showed a non-significant trend toward higher rates in the MIPO group, while hardware-related complications were more frequently observed in the ORIF group.
Conclusion:
Our findings support MIPO as a valuable alternative to ORIF for proximal humerus fractures, offering reduced operative time without compromising reduction quality or complication rates. Patient selection, fracture complexity, and surgeon experience should guide technique choice. Appropriate training remains essential, and future prospective studies incorporating functional outcome measures are warranted.
Level Of Evidence:
Level III, retrospective matched-pair-study.