title: Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers.
abstract: BACKGROUND
  To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers).
  
  
  METHODS
  Forty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered.
  
  
  RESULTS
  Most patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation.
  
  
  CONCLUSIONS
  ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates.
authors.affiliation: Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea.
authors.forename: Abhishek S
authors.initials: AS
authors.lastname: Mahajan
authors.affiliation: Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea.
authors.forename: Young Gun
authors.initials: YG
authors.lastname: Kim
authors.affiliation: Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea.
authors.forename: Jae Hwa
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedics, Dr. V. M. Government Medical College & S. C. S. M. General Hospital, Solapur, India.
authors.forename: Prashanth
authors.initials: P
authors.lastname: D'sa
authors.affiliation: Department of Orthopaedics, Dr. V. M. Government Medical College & S. C. S. M. General Hospital, Solapur, India.
authors.forename: Azhar
authors.initials: A
authors.lastname: Lakhani
authors.affiliation: Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, Korea.
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Ok
mesh_terms: D000328:Adult; D056352:Athletes; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D055815:Young Adult
keywords: Anterior bridge plating; Humeral fractures; Minimally invasive surgery