An Anterosuperior Deltoid Splitting Approach for Plate Fixation of Proximal Humeral Fractures Shin, Dong-Ju; Byun, Young-Soo; Cho, Young-Ho; Park, Ki-Hong; Yoo, Hyun-Seong;
Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.
Traxler H, Surd R, Laminger KA, Windisch A, Sora MC, Firbas W. The treatment of subcapital humerus fracture with dynamic helix wire and the risk of concommitant lesion of the axillary nerve. Clin Anat. 2001;14(6):418-23.
Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14(3):162-6.
Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma. 2007;21(9):628-33.
Bathis H, Tingart M, Bouillon B, Tiling T. Surgical treatment of proximal humeral fractures. Is the T-plate still adequate osteosynthesis procedure? Zentralbl Chir. 2001;126(3):211-6.
Gardner MJ, Griffith MH, Dines JS, Briggs SM, Weiland AJ, Lorich DG. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res. 2005;(434):123-9.
Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22(3):159-64.
Blum J, Rommens PM. Proximal interlocking of humeral intramedullary nails and risk of axillary nerve injury. Unfallchirurg. 2002;105(1):9-13.
Rommens PM, Blum J, Runkel M. Retrograde nailing of humeral shaft fractures. Clin Orthop Relat Res. 1998;(350):26-39.
Hepp P, Theopold J, Voigt C, Engel T, Josten C, Lill H. The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elb Surg. 2008;17(1):21-8.
Lill H, Hepp P, Rose T, Konig K, Josten C. The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach-technique and first results. Zentralbl Chir. 2004;129(1):43-8.
Apaydin N, Uz A, Bozkurt M, Elhan A. The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder. Clin Anat. 2007;20(3):273-7.
Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd. Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res. 2000;(373):259-64.
Abbott LC, Dec J, Saunders JB, et al. Surgical approaches to the shoulder joint. J Bone Joint Surg Am. 1949;31(2):235-55.
Burkhead WZ Jr, Scheinberg RR, Box G. Surgical anatomy of the axillary nerve. J Shoulder Elb Surg. 1992;1(1):31-6.
Kontakis GM, Steriopoulos K, Damilakis J, Michalodimitrakis E. The position of the axillary nerve in the deltoid muscle. A cadaveric study. Acta Orthop Scand. 1999;70(1):9-11.
Abhinav G, Sivaraman B, Matthew N, Grahame JST. A contribution to the calculation of a safe deltoid split. Int J Shoulder Surg. 2008;2(3):52-5.
Lin T, Xiao B, Ma X, Fu D, Yang S. Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures. BMC Musculoskelet Disord. 2014;15:206.