الفهرس 
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Abstract
F
ractures of the humeral shaft comprise 5-7% of all fractures. Incidence rates reveal a bimodal distribution in which there is one small peak during third decade of life, followed by a larger spike during the seventh decade of life.
Various methods are used to treat mid-distal third humeral shaft fractures. Most of the fractures can be effectively treated conservatively. Operative intervention is indicated in special circumstances including (1) failure of closed reduction, (2) intra-articular extension of fractures, (3) neurovascular compromises, (4) associated ipsilateral forearm and elbow fractures, (5) segmental fractures, (6) pathological fractures, (7) open fractures, (8) fractures in polytraumatised patients, (9) bilateral humeral shaft fractures, (10) periprosthetic fractures and (11) transverse or short oblique fractures.
There are several surgical approaches to the humeral shaft, and although they have their own unique advantages and disadvantages, the choice is often guided by fracture location: mid-shaft to more distal fractures are typically approached posteriorly or laterally, whereas the anterior and anterolateral approaches are favored for proximal one-third to mid-shaft fractures. One of the main advantages of an anterolateral approach is the possibility for an Extensile exposure, as the approach can be extended both proximally and distally. The anterolateral approach has also been shown to result in lower rates of iatrogenic radial nerve palsy (4%) compared with lateral (20%) and posterior approaches (11%) while also allowing for supine positioning in polytrauma patients.
Minimally Invasive Plate Osteosynthesis (MIPO) should be included nowadays in the usual practice of each orthopedic surgeon. The term (MIPO) stands for these criteria: Fracture zone is not opened, the fracture hematoma is well preserved, reduction is done by indirect maneuver, small approaches for the application of the implants and intraoperative assessment of the reduction by imaging.
MIPO is a modality which results in a relatively stable fracture construct while preserving a biologic environment that facilitates rapid bone healing. While MIPO is most applicable to the fractures of long bones, particularly, humerus shaft fractures. The reported outcomes of MIPO procedures have been favorable, with rapid stabilization of the fracture site by bridging callus, progressing to complete union. This technique has gained rapid acceptance for fracture shaft of humerus.
The ventral aspect of the humerus offers an approach to MIPO technique that does not interfere with nerves or major blood vessels. Humeral shaft fractures could be effectively treated with the MIPO technique due to the advantages of shorter fracture union time and lower incidence of fracture nonunion, iatrogenic radial nerve palsies, iatrogenic fractures and infections rather than the conventional open reduction and internal fixation technique.
The results obtained in this study have shown that the MIPO technique is safe, convenient and effective, since there was minimal soft tissue injury and no major complications. The plate stability allows a fast rehabilitation with superior functional results comparing with open reduction and internal fixation and this allowed 96% of the patients to return to their normal activities within 6 months. MIPO for humeral shaft fractures provided satisfactory clinical and radiological outcomes considering high union rate and minor complications.
Taken together these results suggesting that recent fracture shaft of humerus could be effectively treated with the MIPO technique due to significant advantages and minor complications if compared to ORIF, with the less operative scars and better cosmesis. This contributes to the high patient satisfaction with this novel treatment.