Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures

Buyukkuscu, Mehmet Ozbey; Kulduk, Ahmet; Mısır, Abdülhamit; Çetinkaya, Engin; Çamurcu, Yalkın; Gürsü, Şükrü Sarper

doi:10.5606/ehc.2020.74218

Cited by 3 publications

(9 citation statements)

References 21 publications

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“…Exposure to the proximal humerus in DS approach is limited by the axillary nerve, which is located 5 mm below the border of the acromion process [4] . The literature reported incidence of axillary nerve injuries ranging from 0% to 33% with the DS approach [15] . However, Visser et al [30] considered axillary nerve injury to be caused by the fracture itself.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 ] The literature reported incidence of axillary nerve injuries ranging from 0% to 33% with the DS approach. [ 15 ] However, Visser et al [ 30 ] considered axillary nerve injury to be caused by the fracture itself. Hepp et al, [ 20 ] Borer et al [ 7 ] and Frank et al [ 8 ] reported no axillary nerve injury in their studies with the use of the DS approach for ORIF in proximal humeral fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Poor functional outcomes observed after ORIF performed via the DP approach might be due to the devascularization of fracture fragments during dissection and plating, the disruption of residual blood supply to the head of the humerus or the destruction of the deltoid insertion. [4,[13][14][15] The DS approach has become a new method for exposing the proximal humerus and has also been applied in rotator cuff surgery and intramedullary nailing. [4,7,13,[16][17][18] This approach consists of entering the proximal humerus fracture between the anterior and middle bands of the deltoid.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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 ]…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Wang

et al. 2022

Medicine

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Background: The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach. Methods: This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score. Results: A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation ( P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups ( P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group ( P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group ( P = .049). Conclusion: The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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 ]…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Liu

Wang

et al. 2022

Medicine

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Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results

Okutan

2022

Journal of Health Sciences and Medicine

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Aim: We aimed to present deltoid split approach under traction in lateral decubitus position that we perform for the treatment of proximal humerus fractures (PHFs) and to present the preliminary surgical and clinical outcomes of our patients. Material and Method: Twelve patients who underwent plate osteosynthesis through a deltoid split approach under traction in lateral decubitus position between May 2019 and January 2021 were evaluated. Patient demographics, Neer classification, and time from injury to surgery were collected in all patients preoperatively. Radiation exposure time and operating time was recorded intraoperatively. Radiological outcomes were assessed, including time to union, and neck-shaft angle. Functional outcomes were evaluated using the Constant score at the minimum 12-month follow-up. Results: Twelve patients (5 male, 7 female) were evaluated with a mean age 58.6±10.7 years (range, 32 to 72 years) at the time of surgery. The mean follow-up period was 117.4±3.8 months). The mean operation time was 60.7±15.2 min (range, 44 to 92 min). The mean radiation exposure time was 6.1±3.0 s (range, 3.3 to 14.2 s). Fracture union was observed in all patients at mean 14.6±2.5 weeks (range, 8 to 20 weeks). The mean neck-shaft angle after the union was 134.5±3.4 degrees (range, 124 to 143 degrees). The mean Constant score was at the final follow-up was 76.4±8.7 (range, 63 to 90). Conclusion: Patient positioning in the lateral decubitus position under traction can be considered as a safe, reliable, and reproducible method in selected patients with PHFs.

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An updated systematic review and meta‑analysis comparing deltoid‑split approach with deltopectoral approach for proximal humerus fractures

Shen

2023

Exp Ther Med

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The present review and meta-analysis aimed to summarize the currently available data and to compare the important clinical and functional outcomes in patients with proximal humerus fractures who were treated using deltoid split (DS) or deltopectoral (DP) surgical approaches. The PubMed, EMBASE, Scopus and Cochrane Central Register of Controlled Trials databases were systematically searched for randomized controlled trials or observational studies that reported functional outcome data of patients with fracture of proximal humerus who were surgically treated using DS and DP approaches. A total of 14 studies were included in the present meta-analysis. The duration of surgery [min; weighted mean difference (WMD), -16.44; 95% CI, -(25.25-7.63)], amount of blood loss [ml; WMD, -57.99; 95% CI, -(102.74-13.23)] and time to bone union [weeks WMD, -1.66; 95% CI, -(2.30-1.02)] was comparatively lower in patients that underwent DS. There were no statistically significant differences in the pain and quality of life scores, range of movement and risk of complications between the DS and the DP groups. Patients in the DS group had improved shoulder function and constant shoulder score (CSS) at 3 months post-surgery (WMD, 6.36; 95% CI, 1.06-11.65). No differences were observed between the two groups in terms of CSS and disabilities of the arm, shoulder and hand scores at 12 and 24 months post-operatively. The activity of daily living (ADL) score was significantly improved in the DS group at 3 (WMD, 1.23; 95% CI, 0.40-2.06), 6 (WMD, 0.99; 95% CI, 0.72-1.25) and 12 months (WMD, 0.83; 95% CI, 0.18-1.47) after the surgery. The present results suggested that DS and DP surgical approaches were associated with similar clinical outcomes. The DS approach was associated with certain perioperative benefits, as well as reduced time to bone union, improved shoulder function in the early postoperative period and improved ADL scores. These benefits may be considered while choosing between these two surgical approaches.

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Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures

Cited by 3 publications

References 21 publications

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

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

Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results

An updated systematic review and meta‑analysis comparing deltoid‑split approach with deltopectoral approach for proximal humerus fractures

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