Anterior Bridge Plate Through Minimally Invasive Approach: A Game-changer for Humeral Shaft Fracture: A Clinical Case...

Conventional open reduction and internal fixation of the humeral shaft often has a high chance of non-union and delayed union, because of primary healing. Furthermore, a shaft humerus fracture can be managed by conservative means. However, the problem of conservative management is stiffness of joints and the possibility of delayed union of fractures. Minimally invasive percutaneous plate osteosynthesis (MIPPO) utilizes the principles of both conservative and surgical management. Healing is through secondary healing, as in conservative management, while maintaining the principles of fixation and early mobilization of joints. The plane utilized for the anterior bridge plate of the humerus is a safe plane without any major neurovascular structures crossing it. We aimed to investigate the safety, feasibility, and advantages of MIPPO via an anterior approach in the treatment of humeral shaft fractures.

Between 2023 and 2025, 13 adult humeral fractures were treated using a minimally invasive anterior bridge plating approach, followed by fixation with a locking compression plate, to evaluate the functional and radiological outcomes of this technique.

A total of 13 patients were included in the study. At the 1-year post-operative follow-up, no cases of infection or nerve damage were reported (0%). Only 1 (07.7%) patient had developed neuropraxia, which recovered. Shoulder function was excellent in 11 cases (84.6%) and good in the remaining 2 (15.4%) cases on the University of California-Los Angeles score. Elbow function was excellent in 9 (69.2%) cases, good in 2 (13.4%) cases, and fair in 2 (13.4%) cases on the Mayo elbow performance score.

No cases of iatrogenic nerve palsy occurred through MIPPO. This approach is easy, feasible, and has better functional results. It can be used as an alternative for the treatment of extra-articular fractures of the middle and distal thirds of the humerus.