Pilon Fractures

Attum, Basem; Gajari, Vamshi; Barei, David P.; Jahangir, A. Alex

doi:10.1007/978-3-319-73392-0_24

Cited by 1 publication

(2 citation statements)

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“…Although no study has been investigated the implant related pressure on adjacent nerves with deltopectoral approach, we believe that effect of the implants should be considered in case of an axillary nerve problem. The motor fibers of the axillary nerve innervate the deltoid and teres minor muscles, while the sensory fibers provide the sensation of the skin above the deltoid muscle (1). Although isolated axillary nerve injury is rare, it may result from post-traumatic compression with fibrous band, recurrent strain injuries, and muscle hypertrophy in the quadrangular space (3,7).…”

Section: / Discussionmentioning

confidence: 99%

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Plate Positioning Affects the Pressure on the Axillary Nerve Following a Deltopectoral Approach

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et al. 2021

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PURPOSE OF THE STUDYTo investigate the pressure levels on the axillary nerve at different plate positions after plate fixation of a proximal humerus fracture. MATERIAL AND METHODSEight fresh-frozen cadaveric specimens were used. The plates were applied on the lateral side of the humerus. A FlexiForce pressure sensor was placed between the nerve and the plate, and the pressure on the nerve was measured (Group 1). The plates were then placed in two different positions such that distal portion of the plates would have 30° anterior and 30°p osterior angles to the anatomical axis of the humerus (Group 2 and 3). The anterior of the distal attachment of the deltoid muscle was then elevated and the plates were placed in the middle of the anatomical axis of the humerus (Group 4). The position of the plates were controlled by fluoroscopy and the pressure was measured for each configuration sequentially. RESULTSThe mean age of the cadavers was 70.5 ± 6.8 years (range: 61-80 years). Mean pressure values of the groups were 2.65 ± 0.8, 2.52 ± 0.8, 5.65 ± 1.4, and 2.56 ± 0.9 N, respectively. Group 3 had statistically highest-pressure values than the other groups, while no difference was found among groups 1, 2, and 4. DISCUSSIONNumbness and weakness of the shoulder muscles are other clinical findings. If numbness on the deltoid muscle is reported, then atrophy is noted in the deltoid muscle in later stages. Persistent pain may be seen even if fracture union occurs after PHF surgery. Axillary nerve entrapment may be considered after the removal of common complications such as avascular necrosis due to fracture, screw migration, infection, and biceps tendon and rotator cuff problems. The sensory branch of the axillary nerve provides the sensation of the anterior joint capsule and lateral part of the deltoid muscle. CONCLUSIONSProximal humerus plates, which are angled posteriorly along, lead to an increased pressure on the axillary nerve. Anterior orientation of the plate or elevation of deltoid insertion may be used to prevent the possible complications related to axillary nerve.Level of evidence Level II.

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Section: / Discussionmentioning

confidence: 99%

“…anterior part of the deltoid muscle (1,8,14). Surgeons tend to avoid the removal of the distal deltoid insertion, in these cases, distal pole of the plate may be oriented to anteriorly or posteriorly.…”

Section: Original Paper Původní Prácementioning

confidence: 99%