Abstract
BackgroundProximal humeral fracture is a common fracture. Different approaches have been utilized in the surgical intervention of three-part fractures. Our study is to evaluate the clinical outcomes and effectiveness of a modified anterolateral approach and intra-osseous portal in minimally invasive treatment for three-part proximal humeral fractures in comparison to the traditional deltopectoral approach.MethodsFrom March 2015 to September 2016, 13 patients with three-part proximal humeral fractures were treated with internal fixation through the modified anterolateral minimally invasive approach (MIPO). These cases were compared to 20 additional cases using the deltopectoral approach (DP). Clinical and radiographic evaluations were performed, including the constant score (CS) and range of motion in abduction, flexion/extension and external/internal rotation. Complications were recorded as well.ResultsAll patients were followed up for a mean time of 12.12 ± 4.01 months. At the latest follow-up, no significant differences (p < 0.05) were observed in terms of length of stay, range of motion for abduction, flexion or internal/external rotation of the shoulder, Constant score or visual analog scors (VAS) for pain. Elbow flexion (142.31 ± 8.32 vs. 123.00 ± 10.18), posterior shoulder extension (41.92 ± 5.22 vs. 35.50 ± 5.83) and postoperative VAS (4.38 ± 1.04 vs. 6.15 ± 0.99) were significantly better in the MIPO group than in the DP group (p < 0.05). No significant differences were detected in the radiographic evaluation, and complications including axillary nerve injury were not present.ConclusionThe use of the modified anterolateral approach and intra-osseous portal is safe and effective for minimally invasive reduction and plating treatment for three-part proximal humeral fractures.
Highlights
IntroductionProximal humeral fracture (PHF) is a common fracture, accounting for 5% of total fractures and 39.7% of humeral fractures in the Chinese population [1]
Proximal humeral fracture is a common fracture
The classic deltopectoral approach has been used for years, especially for the open reduction and internal fixation (ORIF) of three- and four-part proximal humeral fractures
Summary
Proximal humeral fracture (PHF) is a common fracture, accounting for 5% of total fractures and 39.7% of humeral fractures in the Chinese population [1]. Considering the poor bone quality of the proximal humerus in aging patients, locking plate fixation remains the standard for surgical treatment. The classic deltopectoral approach has been used for years, especially for the open reduction and internal fixation (ORIF) of three- and four-part proximal humeral fractures. This approach provides limited access to the posterolateral aspect of the shoulder, and viewing the retracted greater tuberosity fragment in this area may be difficult.
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