The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Factors Associated with Use of a Posterior Approach and Use of Minimally Invasive Plate Osteosynthesis for Plate and Screw Fixation of Middle Third Humeral Diaphysis Fracture

Document Type : RESEARCH PAPER

Authors
Elizabeth Duckworth
Melle Broekman
Chase Romere
David Ring
Austin Hill
Dave Laverty
Dell Medical School, University of Texas at Austin; Austin TX, USA
10.22038/abjs.2025.88385.4006
Abstract
Objectives: We sought factors associated with use of a relatively unconventional use of a posterior surgical exposure and fixation for management of middle third humeral diaphysis fractures.
Methods: In a scenario-based experiment 112 surgeon participants of the Science of Variation Group (SOVG)–an international collaboration of fracture surgeons that study sources of variation in care– viewed 11 sets of radiographs of 9 middle and 2 distal third fractures of the humeral diaphysis. The primary response variable was decision to use a posterior surgical approach and fixation. The secondary response variable was additional use of a minimally invasive plate osteosynthesis (MIPO) technique. Logistic regression analysis assessed the impact of gender, continent of practice, years in practice, subspecialty, location of fellowship, volume of fractures treated per year, and location of fracture.
Results: Factors associated with recommendation of a posterior approach included 6-10 years in practice (β 0.96; 95% CI 0.55 to 1.4) and identifying as a fracture surgeon (β 0.42; 95% CI 0.06 to 0.78). Fracture location in the middle third of the humeral shaft was associated with decreased likelihood to recommend a posterior approach (β -2.2; 95% CI -2.6 to -1.7) as was practicing for 21 to 30 years (β -0.65; 95% CI -1.0 to -0.25). Factors associated with use of a MIPO technique included practicing outside of the US and Europe (β 0.91 95% CI 0.47 to 1.3) and 21-30 years of practice (β CI 0.71 95% CI 0.20 to 1.2) (all p < 0.05).
Conclusion: The observed association between distal third fracture location and posterior exposure for plate and screw fixation of a diaphyseal humerus fracture suggests that a posterior plate location may be a marker of relative surgeon unfamiliarity with fracture fixation surgery in this region.
Level of evidence: IV
Keywords
Fracture
Surgical approaches
Variations in care
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 10
October 2026
Pages 656-661

  • Receive Date 02 June 2025
  • Revise Date 12 November 2025
  • Accept Date 15 November 2025