Anterolateral Approaches for Proximal Humeral Osteosynthesis: A Systematic Review

Abstract

Objective: Anterolateral approaches for proximal humerus osteosynthesis have great advantages because they allow direct exposure of the lateral aspect of the humerus without the muscular retraction seen in the deltopectoral approach. However, much resistance is found among surgeons due to the potential risk of iatrogenic injury to the axillary nerve. To identify the incidence of axillary nerve iatrogenic lesions and evaluate the functional results of proximal humerus osteosynthesis with locking plates using anterolateral approaches. Methods: The literature review followed the PRISMA protocol. Results: A total of 23 articles were selected from 786 patients submitted to anterolateral approaches. Three cases (0.38%) of iatrogenic axillary nerve lesions were confirmed. The results of the functional tests were similar to those of the deltopectoral approach. Conclusion: Anterolateral approaches are a viable and safe alternative for proximal humerus osteosynthesis with locking plate. Subacromial impingement was the most frequent complication. Level of Evidence II, Systematic Review.

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach

“…In this study, none of the patients in the DI group were found to have clinical neurological signs of axillary nerve injury. This was consistent with previous reports [7,8,19,20] . In our opinion, the DI is a modification of the DS by extending the skin incision further distally beyond the area of the axillary nerve, which is directly visualized and protected.…”

“…This was consistent with previous reports. [ 7 , 8 , 19 , 20 ] In our opinion, the DI is a modification of the DS by extending the skin incision further distally beyond the area of the axillary nerve, which is directly visualized and protected.…”

“…However, the approach results in a high risk of iatrogenic injury to the axillary nerve, which is considered to be a limitation. [7,15,19] A modified DS approach, named after the deltoid interfascicular (DI) approach, has been proposed for the treatment of displaced proximal humerus fractures. [16,20] This study aims to introduce the DI approach and compare the clinical outcomes and complications of displaced proximal fractures of the humerus treated with ORIF using a proximal humeral internal locking system (PHILOS) plate via the DI approach compared with the DP approach.…”

“…However, the approach results in a high risk of iatrogenic injury to the axillary nerve, which is considered to be a limitation. [ 7 , 15 , 19 ]…”

Augmented cerclage wire improves the fixation strength of a two-screw construct for humerus split type greater tuberosity fracture: a biomechanical study

“…Some surgeons advocate plate and screw fixation for split GT fracture, and biomechanical study reveals that locking plate fixation provides the strongest and stiffest biomechanical fixation for split type greater tuberosity fractures [ 36 , 37 ]. However, there remain concerns of more deltoid muscle dissection, axillary nerve injury [ 38 ], and subacromial impingement after osteosynthesis with plate and screws [ 39 ]. Previous studies have reported good functional recovery in treating isolated GT fractures with screw fixation [ 17 – 19 ].…”