Abstract
BackgroundWith the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. However, the optimal method for open reduction and internal fixation (ORIF) remains controversial.MethodsWe performed a retrospective analysis of patients with PHF who underwent locking plate internal fixation at our institution from January 2016 to December 2018. Patients were divided into two groups based on the surgical approach used: an expanded deltoid-split approach group (ORIF group) and minimally invasive deltoid-split approach group (minimally invasive percutaneous plate osteosynthesis, [MIPPO] group). The groups were compared in terms of demographic and perioperative characteristics, and clinical outcomes.ResultsA total of 115 cases of PHF were included in our study, of which 64 cases were treated using the minimally invasive deltoid-split approach and 51 using the extended deltoid-split approach. Fluoroscopy was performed significantly less frequently in the ORIF group and the surgical duration was shorter. However, the postoperative visual analogue scale (VAS) pain score and duration of postoperative hospital stay were significantly higher compared to the MIPPO group. Moreover, secondary loss was significantly less extensive in the ORIF group compared to the MIPPO group, while there was no significant group difference in fracture healing time, Constant shoulder score, or complications at the last follow-up visit.ConclusionsThe clinical outcomes associated with both the minimally invasive and extended deltoid-split approaches were satisfactory. The data presented here suggest that the extended deltoid-split approach was superior to the minimally invasive deltoid-split approach in terms of operational time, fluoroscopy, and secondary loss of reduction, while the minimally invasive approach was superior in terms of postoperative pain and hospital stay. Accordingly, neither procedure can be considered definitively superior; the optimal surgical procedure for PHF can only be determined after full consideration of the situation and requirements of the individual patient.
Highlights
With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased
A total of 115 cases of PHF patients were included in our study, of which 64 (55.7%) were treated using the minimally invasive deltoid-split approach (MIPPO group), and 51 (44.3%) using the extended deltoid-split approach (ORIF group)
There were no significant differences in fracture classification, medial support status, American Society of Anesthesiologists (ASA) score, or type of anesthesia, the incidence rates of intraoperative fluoroscopy (4.37 ± 0.72 versus 7.27 ± 0.93, p < 0.001) and surgical duration (62.94 ± 10.18 min versus 82.25 ± 12.36 min, p < 0.001) were significantly lower, while the postoperative visual analogue scale (VAS) score was significantly higher (6.33 ± 1.05 versus 4.78 ± 1.16, p < 0.001), and the postoperative hospital stay significantly longer (5.14 ± 1.58 days versus 3.81 ± 1.08 days, p < 0.001), in the open reduction and internal fixation (ORIF) group compared to the minimal invasive percutaneous plate osteosynthesis (MIPPO) group
Summary
With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. The optimal method for open reduction and internal fixation (ORIF) remains controversial. Open reduction and internal fixation (ORIF), minimal invasive percutaneous plate osteosynthesis (MIPPO), intramedullary nail internal fixation and arthroplasty are the most common surgical interventions for PHF [7], with ORIF with locking plate being the most common [8]. The minimally invasive deltoid-split approach can alos further reduce soft tissue damage, allowing patients to exercise the affected shoulder joint earlier. Recent studies have reported that the use of the MIPPO technique in combination with the deltoid-split approach may affect the blood supply to the humeral head and cause axillary nerve injury [12, 13]
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