A Technical Note to Improve Surgical Access, When Fixing Proximal Humeral Fractures With the AxSOS Lateral Proximal Humeral Plate (Stryker)

Abstract

Fixation of proximal humeral fractures with a low profile contoured locking proximal humeral plate is a well recognized and practiced technique. Open reduction and internal fixation of these fractures is typically performed through either a delto-pectoral or deltoid splitting approach. In our unit the AxSOS (Stryker) lateral proximal humeral plate is utilized for the fixation of proximal humeral fractures through a delto-pectoral approach. This plate is shaped to the proximal humerus so that the distal part of the plate is contoured to sit more posteriorly on the shaft of the humerus compared with the proximal part. By utilizing the contralateral lateral proximal humeral plate, that is, the right-sided plate on a left humerus, the access to the distal end of the plate is greatly improved and avoids difficult access or the need to detach part of deltoids’ insertion. In the senior author’s experience, due to the contour of the plate, the distal end of the correctly sided (ipsilateral) plate has a tendency to lie posteriorly to the insertion of deltoid. The resultant plate position is therefore often technically challenging to achieve drill guide and locking screw insertion. By using the contralateral-sided plate it allows for an improved distal plate position that is readily accessible and avoids the requirement for excessive retraction or detachment of deltoids insertion.