Abstract
There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61–74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11–34) months. The fractures united in an average of 7.2 (6–14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.
Highlights
The proximal humeral fracture is a common fracture of the upper extremity [1]
The traditional anterior deltopectoral approach has been most commonly used for plating of the proximal humerus
The patients were treated with minimal invasive percutaneous plate osteosynthesis (MIPPO) using proximal humeral internal locking system (PHILOS)-plate
Summary
The proximal humeral fracture is a common fracture of the upper extremity [1]. Valgus impacted proximal humeral fractures present several problems, such as complex anatomy, risk of avascular necrosis [2], and minimal bone stock, which must be considered in order to achieve satisfactory treatment results. The traditional anterior deltopectoral approach has been most commonly used for plating of the proximal humerus This approach requires extensive soft tissue dissection and may impair the anterior circumflex humeral artery; the exposure of the plating zone is different [4]. The anterolateral deltoid-splitting approach minimizes soft tissue dissection and has the merits of easy access and excellent visualization of the greater tuberosity and the plating area [5]. It provides easier access to the infraspinatus insertion for application of stay sutures. Another benefit is indirect reduction by ligamentotaxis and by reduction to the plate in a valgus displaced fracture configuration [6]
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