Comparison between minimally invasive plate osteosynthesis and the deltopectoral approach with allogenous fibular bone graft in proximal humeral fractures

Abstract

Background: Both allogenous fibular bone graft and minimally invasive plate osteosynthesis have been developed to reduce issues such as fixation failure, displacement, angulation, and nonunion after plate fixation of proximal humeral fractures. However, there have been no studies investigating the differences in clinical results between these methods. The purpose of this study was to investigate the clinical differences between open reduction and plate fixation via a deltopectoral approach with allogenous fibular bone graft and a minimally invasive approach, in Neer's classification two-, three-part proximal humeral fractures.Methods: In this retrospective study, 77 patients with Neer classification two-, three-part proximal humeral fractures were treated at two different institutions. Clinical and radiological evaluations were performed in 39 patients who underwent minimally invasive plate osteosynthesis at one institution (group A) and 38 patients who underwent the deltopectoral approach with allogenous fibular bone graft at another institution (group B). The results between the groups were compared.Results: The minimally invasive plate osteosynthesis procedure (group A) was significantly less time- consuming and caused less bleeding than allogenous fibular bone graft through a deltopectoral approach (group B) (P<0.05). The duration of the fracture union was significantly reduced in group A (14.5±3.4 weeks; range, 10–22 weeks) compared to group B (16.4±4.3 weeks; range, 12–28 weeks) (P<0.05). There were no statistically significant differences between the two groups when evaluating the visual analog scale and Constant scores 1 year postoperatively. Radiological evaluation including neck-shaft angle and plate height were measured on the final follow-up X-ray image. There was no difference in radiological outcomes between the two groups. There were no statistically significant differences in malunion between the two groups; there were three malunion cases (7.7%) in group A and four (10.5%) in group B.Conclusions: The minimally invasive plate osteosynthesis procedure and deltopectoral approach with allogenous fibula bone graft for Neer's classification two-, three-part proximal humeral fractures demonstrated similar clinical and radiological results. However, allogenous fibula grafts require longer surgery, cause more bleeding, and result in longer fracture healing time than the minimally invasive plate osteosynthesis procedure.

Effects of fibular strut augmentation for the open reduction and internal fixation of proximal humeral fractures: a systematic review and meta-analysis

“…No article was judged to be of poor quality. Two articles [ 14 , 15 ] were excluded because other techniques that might be a potential confounding factor to the clinical result were used, thus leaving eight studies that were considered to be suitable for the inclusion in this review [ 9 , 10 , 16 – 21 ] (Fig. 1 ).…”

“…No difference was noted in terms of intraoperative blood loss according to Chen [ 9 ]. An increased likelihood of operative duration associated with the application of FSAs was detected in Kim [ 15 ].…”

“…An increased likelihood of operative duration associated with the application of FSAs was detected in Kim [ 15 ].…”

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

“…However, exposure to the posterior aspect of proximal humerus will be difficult [4,20] . Forceful deltoid muscle retraction and extensive soft tissue dissection are needed [24,25] . Conversely, the DI approach is a relatively minimally invasive method of ORIF.…”

Is Device Removal Necessary after Fixed-Angle Locking Plate Osteosynthesis of Proximal Humerus Fractures?

“…Proximal humerus fractures may be a significant cause of morbidity with loss of independence [ 1 , 2 ]. Despite controversy regarding proper treatment of proximal humeral fractures, most surgeons support operative treatment of unstable or displaced fractures [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Compared to conservative treatment, open reduction and internal fixation (ORIF) enables the early return of function and decreases the incidence of malunion or nonunion [ 9 ].…”