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Abstract
BackgroundCurrent treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. The aim of this study was to evaluate the clinical outcome of MIPPO versus ORIF via the deltoid-pectoralis approach in elderly patients with proximal humeral fractures.MethodsThirty-six patients with proximal humeral fractures were enrolled in this study. Following the randomized block and single-blinded principle, the patients were assigned to two groups and treated with either conventional ORIF or MIPPO, both through the deltoid-pectoralis approach. Surgical outcomes were evaluated by the NEER score, Constant-Murley score, blood loss, length of operation, radiological imaging and clinical examination. The patients were followed up for 4–24 (mean 10) months.ResultsAccording to Constant-Murley score, the surgical outcome was excellent in 14 cases, satisfactory in 2 cases and unsatisfactory in one case in MIPPO group versus 10, 5 and 4 in conventional ORIF group. MIPPO was significantly advantageous over conventional ORIF in terms of NEER score, Constant-Murley, length of operation and intraoperative blood loss. In addition, MIPPO was also more advantageous in several indexes in patients with BMI > 26.0 and NEER type III fracture.ConclusionThe results of our study have demonstrated that MIPPO through the deltoid-pectoralis approach is an effective alternative for the treatment of proximal humeral fractures in elderly patients.Trial registrationThe trial registration number (TRN): ChiCTR-INR-17011098 (retrospectively registered at 2017-04-09)
Highlights
Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-splitting approach
The aim of the present study was to verify the advantages of the MIPPO technique through the deltoid-pectoralis approach by comparing the clinical outcomes of 17 cases treated with this technique and 19 cases treated with conventional ORIF through the deltoid-pectoralis approach in terms of NEER/Constant-Murley Score, intraoperative blood loss, length of operation and union time
Two groups showed no significant difference in the statistical results of visual analogue scales (VAS) and union time
Summary
Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. Zhao et al BMC Musculoskeletal Disorders (2017) 18:187 the lateral deltoid approach using the MIPPO technique was recently reported to associated with a risk of damage to blood supply of the deltoid and axillary nerve [4, 11, 15,16,17,18,19,20,21,22,23,24,25,26,27,28] Compared with this approach, the deltoidpectoralis approach requires extensive soft tissue reduction and may damage the anterior circumflex humeral artery and cephalic vein [16]. The aim of the present study was to verify the advantages of the MIPPO technique through the deltoid-pectoralis approach by comparing the clinical outcomes of 17 cases treated with this technique and 19 cases treated with conventional ORIF through the deltoid-pectoralis approach in terms of NEER/Constant-Murley Score, intraoperative blood loss, length of operation and union time
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