Comparison of minimally invasive osteosynthesis and open reduction and internal fixation of proximal humerus fractures

About 5-6% of all fractures occur in damage to the proximal humerus. Treatment depends on many factors, including the degree of fracture displacement, the patient's activity level, associated injuries and diseases, age, fracture type, and bone quality. The most acceptable surgical options are open reduction and internal fi tion (ORIF), minimal invasive plate osteosynthesis (MIPO).Purpose of the study: to compare the results of studies of minimally invasive and open techniques of osteosynthesis of the proximal humerus.Materials and methods: PubMed, EMBASE, Cochrane Library, ScienceDirect, WebOfScience were searched to fi d all relevant studies in the period 2015-2023. In addition, the literature lists of relevant studies were searched. There were no linguistic restrictions.Results: Selected 24 studies by design were retrospective studies, 9 articles were devoted only to the MIPO technique, 1 clinical case was bilateral ORIF. A total of 1698 patients were analyzed in the studies. The mean follow-up period was 25.2 months. The mean age of the patients was 61.3 ± 8 years. The most common complications were avascular necrosis of the humeral head, subacromial impingement, screw perforation, infection of the postoperative wound area, varus collapse (loss of medial support), nonunion, and axillary nerve injury. Compared to ORIF, MIPO has advantages in terms of operative time, tuberculum major reposition, blood loss, postoperative pain, early postoperative shoulder function, and cosmetic outcome. MIPO requires a longer intraoperative x-ray time. MIPO requires a longer intraoperative x-ray time and is not indicated for multifragmentary fractures according to few articles. There was no signifi ant difference in complication rates between these methods.Conclusion: Until now, ORIF is the standard osteosynthesis technique for complex multifragmentary fractures. However, it does not differ signifi antly from the minimally invasive technique. The MIPO technique shows itself to be promising and requires an expansion of indications for use.