Operative time, postoperative pain, and functional recovery in MIPO versus ORIF for humeral shaft fractures: a retrospective cohort case series

Background: Minimally invasive plate osteosynthesis (MIPO) for humeral diaphyseal fractures could result in better outcomes than
open reduction and internal fixation (ORIF). However, the relationship between operative time, postoperative pain, and functional
outcomes with respect to the use of standard dynamic compression plates (DCP) remains unclear. Therefore, this study aimed to
evaluate the correlation between surgical duration, postoperative pain, and functional outcomes.
Methods: A cohort case series of 28 patients with humeral shaft fractures was grouped into 12A1–12C3. MIPO and ORIF were
performed in 13 and 15 patients, respectively. The study assessed demographic, surgical, complications, surgery duration (min),
and pain levels 24 h postoperatively. Outcomes were measured using the UCLA shoulder rating score and Mayo Elbow
Performance Score (MEPS). Bone union was assessed using the Radiographic Union Score for Humeral Fractures and bone
bridges. Propensity score matching (PSM) was used to adjust for the covariates. Spearman’s test assessed correlations.
Results: Twenty-eight patients and 13 matches (n = 26) were analyzed after PSM. 24 h pain levels were compared between
groups (MIPO 4 vs. ORIF 6, P = 0.04). The MIPO group exhibited an inverse correlation between pain and UCLA scores at 3
months (Rho = − 0.48; P = 0.02). UCLA scores revealed differences at 3, 6, and 24 months (MIPO 29, 35, 35 vs. 25, 33, 34 for
ORIF) (P = 0.01, 0.03, and 0.03, respectively). Intragroup UCLA assessments in both groups were (P < 0.001). MEPS demonstrated no differences within or between groups.
Conclusions: UCLA assessment at 3 months in both groups manifests a weak inverse correlation with postoperative pain. MIPO could
be associated with reduced operative time, blood loss, and pain. It may lead to expedited functionality recovery, less radial nerve lesions,
and pseudarthrosis when using DCP, which may be beneficial in resource-limited hospitals with a high patient’s demand.