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

Liu, Bin; Wang, Xinguang; Wang, Chao; Jiao, Zhenqing; Chen, Wei

doi:10.1097/md.0000000000029075

Cited by 2 publications

(1 citation statement)

References 33 publications

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“…Percutaneous Kirschner wires, plates, intramedullary nails, and arthroplasty are commonly used surgical methods in clinical practice. The surgical method of plate internal xation through the deltopectoral approach is the most commonly used by surgeons [2][3][4]. Although this surgical approach has a large exposure range, it has the disadvantage of large incisions and extensive soft tissue and blood supply damage, which also increases the risk of delayed union and ischemic necrosis of the humeral head [5].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive plate osteosynthesis of proximal humerus fractures through a modified anterior subacromial approach

Ye,

Yu,

Lin

et al. 2023

Preprint

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Purpose Proximal humeral fractures are usually treated through the deltopectoral approach and direct lateral deltoid-split approach. The direct lateral deltoid-split technique has a minor incisional injury but restricted exposure, whereas the deltopectoral approach has a somewhat significant incisional injury but greater exposure is possible. To combine the advantages of a less invasive incision with enough exposure, this study's objectives was to propose a modified anterior subacromial (MAS) approach for treating proximal humerus fractures and to assess its radiological and clinical results. Methods A retrospective analysis was performed on 35 patients with proximal humerus fractures treated with a MAS approach, including 15 males and 20 females, with an average age of 61.7 years. According to the Neer classification, seven patients had 2-part fractures, 10 patients had 3-part fractures, and 18 patients had 4-part fractures. Quantitative variables including operative time, incision length, follow-up time, and Constant-Murley score for shoulder function, fracture union time, and neck-shaft angle (NSA) were recorded. Qualitative variables including intraoperative and postoperative complications were assessed. Results All cases achieved bony union, and the average healing time was 11.8±1.4 weeks (range, 10–15 weeks). During a mean follow-up of 22.1±5.8 months (range, 14-31 months), the mean incision length was 80.7±2.5 mm (range, 76–90 mm). The pain score at the last follow-up was 1.63±0.7 (range, 1–3). The Constant-Murley score of shoulder joint function at the last follow-up was 89.6±2.9 (range, 84–95). The complications such as ischemic necrosis of the humeral head and varus collapse at the fracture site, as well as sensory deficits in the distribution of the axillary nerve or anterior deltoid paralysis, were not observed. The mean NSA at the last follow-up was 133.4±3.1° (range, 128°-138°). In terms of statistical significance, there was no difference between fractures of Neer types 2, 3, and 4. Conclusion The MAS approach has the properties of minimally invasive incision and effective exposure, which has advantages in reduction, plate placement, and inferomedial calcar screw (IMCS) placement of proximal humeral fractures. This approach is a useful alternative to the deltopectoral approach or direct lateral deltoid-split approach in the treatment of proximal humeral fractures.

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Section: Introductionmentioning

confidence: 99%

Minimally invasive plate osteosynthesis of proximal humerus fractures through a modified anterior subacromial approach

Ye,

Yu,

Lin

et al. 2023

Preprint

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A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications

Kwisda

Imiolczyk

et al. 2023

JCM

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The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications.

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

Cited by 2 publications

References 33 publications

Minimally invasive plate osteosynthesis of proximal humerus fractures through a modified anterior subacromial approach

Minimally invasive plate osteosynthesis of proximal humerus fractures through a modified anterior subacromial approach

A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications

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