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Tomasz Poboży

Anterior MIPO or posterior ORIF for distal-third humeral shaft fractures?

Autor:

Tomasz Poboży

Polish version: MIPO czy tylne ORIF w złamaniach dalszej części trzonu kości ramiennej?

A small randomized trial in the Journal of Orthopaedic Trauma compared two operations for extra-articular distal-third humeral shaft fractures: anterior minimally invasive plate osteosynthesis (MIPO) using a reversed PHILOS plate and posterior open reduction and internal fixation (ORIF) using an extra-articular locking compression plate (EA-LCP).

Why this study matters

Fixation in this region must balance stability with protection of soft tissues and the radial nerve. MIPO may reduce dissection and blood loss, but requires fluoroscopy and provides less direct visual control of fracture fragments. The trial examined whether these technical differences affect union and limb function.

Study design

This prospective randomized trial at a single Level 1 trauma centre in New Delhi enrolled 30 adults aged 18–55 years with extra-articular distal-third humeral shaft fractures (AO/OTA 12A–C), presenting within 2 weeks of injury. Fourteen underwent anterior MIPO and 16 posterior ORIF. Radiographic union, Mayo Elbow Performance Score (MEPS), UCLA shoulder score, elbow range of motion, operating time, blood loss, radiation exposure, pain and complications were assessed through 6 months.

Main results

  • Radiographic union: 16.3 ± 1.3 weeks after MIPO versus 18.1 ± 1.2 weeks after ORIF (P = 0.001).
  • Operating time: 78.9 ± 24.4 versus 112.6 ± 42.0 minutes (P = 0.013).
  • Blood loss: 182.1 ± 137.4 versus 328.1 ± 96.8 mL (P = 0.002).
  • Pain on postoperative day 2: VAS 7 ± 0.5 versus 8 ± 0.6 (P < 0.001).
  • Function at 6 months: no significant differences; MEPS 100 versus 100, UCLA 33.8 ± 0.3 versus 33.7 ± 0.4, and elbow range of motion 137.8 ± 2.5° versus 135.4 ± 3.0°.
  • Fluoroscopy: greater exposure with MIPO, 1.5 ± 1.0 versus 0.3 ± 0.5 mGy (P = 0.003).
  • Radial nerve palsy: 1 case after MIPO and 3 after ORIF; all resolved.
  • Nonunion: 1 case in each group, both requiring revision.

Clinical interpretation for an orthopaedic surgeon

MIPO offered perioperative advantages and slightly earlier radiographic union in this small sample, while function at 6 months was essentially the same. These findings support anterior MIPO as a reasonable alternative, rather than proving clear overall superiority.

The approximately 1.8-week difference in union time was statistically significant, but its functional importance for individual patients was not established. The number of radial nerve palsies was also too small for a reliable comparison of complication risk.

Limitations

  • Only 30 patients were included at a single centre.
  • Follow-up was limited to 6 months.
  • The sample was too small to compare rare complications reliably.
  • Operating time and blood loss may depend on the team’s experience with each technique.
  • The findings concern selected younger adults with extra-articular distal-third shaft fractures.

Implications for practice

Anterior MIPO with a reversed PHILOS plate may be an alternative to posterior ORIF for appropriately selected fractures. The study does not establish MIPO as the preferred treatment for every patient, demonstrate a lower risk of radial nerve injury, or prove better long-term outcomes.

References

Garika SS, Yadav P, Jyoti NJ et al. Comparative Efficacy of Anterior MIPO With PHILOS Versus Posterior ORIF With EA-LCP in Distal-Third Humerus Fractures: A Randomized Controlled Trial. J Orthop Trauma. 2026;40(9):482–491. DOI: 10.1097/BOT.0000000000003200. PMID: 42048119.

This summary is based solely on the publicly available abstract and PubMed metadata.

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For Doctors and Physiotherapists · Research Updates, Literature and Evidence-Based Medicine

Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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