Minimally Invasive Posterior Plating for Comminuted Middle to Distal One-Third Humeral Shaft Fractures: A Case Report.

Introduction: Humeral shaft fractures constitute 1-1.5% of all fractures, with most occurring in the middle and distal segments. While conservative treatment is common, surgical fixation is often preferred for displaced or comminuted fractures, particularly in young, active individuals. Minimally invasive plate osteosynthesis (MIPO) techniques have been developed to minimize soft-tissue damage and reduce the risks of complications such as non-union and radial nerve palsy. Although anterior approaches are well-studied, the posterior approach remains less explored. This case report highlights the use of a minimally invasive posterior approach similar to MIPO for treating a highly comminuted middle to distal 1/3rd humeral shaft fracture.

Case report: A 25-year-old woman presented with a comminuted middle to distal one-third humeral shaft fracture after a fall. Due to the small size of the distal fragment, anterior plating was unfeasible. A conventional posterior incision from deltoid to lateral supracondylar ridge was made. A minimally invasive triceps split was done with minimal soft-tissue disruption. Radial neurovascular bundle was isolated and protected. An anatomical extra-articular plate was inserted via a submuscular tunnel, and four distal screws were fixed. The patient began early mobilization postoperatively, and at 5 months, X-rays confirmed fracture union, with full functional recovery of the left upper extremity.

Conclusion: This case demonstrates the successful use of a minimally invasive posterior approach albeit with a conventional posterior incision for distal comminuted humeral fractures. Comparable to the MIPO technique, this technique prioritizes the preservation of soft-tissue envelope around the fracture fragments, blood supply, and muscle integrity, resulting in favorable outcomes and minimal complications. It supports minimally invasive posterior techniques as a safe and effective alternative for complex distal humeral fractures, warranting further research into its long-term outcomes.