Abstract
Introduction
Locked plating for complex proximal humerus fractures through a deltopectoral incision can be difficult due to the fracture morphology and need for fixed angle screws. Although good results have been reported with the deltopectoral approach; technical difficulties, excessive soft tissue stripping and fears of avascular necrosis have lead to the use of minimal access techniques.
Method
Fifteen patients with three or four part fractures were treated by locked plating through a mini-invasive lateral trans-deltoid approach. All patients were relatively young with good bone quality and had sustained a high-velocity injury. Initial closed reduction was attempted in all patients, but majority of the patients (9/15) required open reduction to achieve a satisfactory reduction.
Results
Union was achieved in all patients. All fractures united with an acceptable alignment. There were no incidences of axillary nerve palsy. There were no incidences of hardware failure or loss of reduction. There were no incidences of avascular necrosis at 1-year follow-up. The mean normalized constant score at last follow-up was 85.24.
Conclusion
Locked plating through lateral trans-deltoid incision may offer a better alternative to the deltopectoral approach in these complex fractures where locked plating is contemplated. It respects the fracture biology, allows ease in placement of the locking plate and angle stable screws and offers a stable construct with less surgical morbidity.
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References
Chudik SC, Weinhold P, Dahners LE (2003) Fixed-angle plate fixation in simulated fractures of the proximal humerus: a biomechanical study of a new device. J Shoulder Elbow Surg 12:578–588
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Edwards SL, Wilson NA, Zhang LQ et al (2006) Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques. J Bone Joint Surg Am 88:2258–2264
Esser RD (1994) Open reduction and internal fixation of three- and four-part fractures of the proximal humerus. Clin Orthop 299:244–251
Fankhauser F, Boldin C, Schippinger G et al (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop 430:176–181
Gallo RA, Zeiders GJ, Altman GT (2005) Two-incision technique for treatment of complex proximal humerus fractures. J Orthop Trauma 19:734–740
Gardner MJ, Griffith MH, Dines JS et al (2004) A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Joint Dis 62:18–23
Gardner MJ, Voos JE, Wanich T et al (2006) Vascular implications of minimally invasive plating of the proximal humerus fractures. J Orthop Trauma 20:602–607
Gerber C, Schneeberger AG, Vinh TS (1990) The arterial vascularization of the humeral head: an anatomical study. J Bone Joint Surg Am 72:1486–1494
Gerber C, Werner CM, Vienne P (2004) Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 86:848–855
Haidukewych GJ (2004) Innovations in locking plate technology. J Am Acad Orthop Surg 12:205–212
Jaberg H, Warner JJ, Jakob RP (1992) Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Am 74:508–515
Katolik L, Romeo A, Cole B, Verma N, Hayden J, Bach B (2005) Normalization of the constant score. J Shoulder Elbow Surg 3:279–285
Ko JY, Yamamoto R (1996) Surgical treatment of complex fracture of the proximal humerus. Clin Orthop 327:225–237
Laflamme Y et al (2008) Percutaneous humeral plating of fractures of the proximal humerus: results of a prospective multicenter clinical trial. J Orthop Trauma 22:153–158
Lind T, Kroner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108:285–287
Martini M (1976) The sub-deltoid approach to the metaphyseal region of the proximal humerus. J Bone Joint Surg Am 58:377–379
McLaughlin H (1959) Injuries of the shoulder and arm. In: McLaughlin H (ed) Trauma. WB Saunders, Philadelphia, pp 233–298
Park MC, Murthi AM, Roth NS, Blaine TA, Levine WN, Bigliani LU (2003) Two-part and three-part fractures of the proximal humerus treated with suture fixation. J Orthop Trauma 17:319–325
Rees J, Hicks J, Ribbans W (1998) Assessment and management of three- and four-part proximal humeral fractures. Clin Orthop 353:18–29
Resch H, Povacz P, Frohlich R et al (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79:295–300
Robinson CM, Page RS (2004) Severely impacted valgus proximal humeral fractures. J Bone Joint Surg Am 86:143–155
Schai P, Imhoff A, Preiss S (1995) Comminuted humeral head fractures: a multicenter analysis. J Shoulder Elbow Surg 4:319–330
Schlegel TF, Hawkins RJ (1994) Displaced proximal humeral fractures: evaluation and management. J Am Acad Orthop Surg 2:54–66
Smith J, Berry G, Laflamme Y et al (2007) Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury 38(2):206–211
Zuckerman JD, Cuomo F, Koval KJ (1997) Proximal humeral replacement for complex fractures: indications and surgical technique. Instr Course Lect 46:7–14
Zyto K, Ahrengart L, Sperber A et al (1997) Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 79:412–417
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Gavaskar, A.S., Muthukumar, S. & Chowdary, N. Biological osteosynthesis of complex proximal humerus fractures: surgical technique and results from a prospective single center trial. Arch Orthop Trauma Surg 130, 667–672 (2010). https://doi.org/10.1007/s00402-009-1028-0
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DOI: https://doi.org/10.1007/s00402-009-1028-0