Abstract
BackgroundThe deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture. Although adhesions between the deltoid, plate, and humerus are common sequelae of plate ORIF, little is known about their effect on the range of movement and a function of the shoulder. To confirm their impact, the preoperative and intraoperative evaluation of the range of motion (ROM) was measured during the sequential arthroscopic release of adhesions, with special regard to external rotation. Postoperative ROM and subjective shoulder function were also evaluated.MethodsEighteen patients treated with ORIF of the proximal humerus were scheduled to the unified arthroscopic procedures comprising sequential limited subacromial bursectomy, removal of the adhesions between the deltoid, plate, and humerus, as well as the plate removal. The ROM of the operated and opposite shoulders were assessed before surgery, intraoperatively and after a minimum two-year follow-up, with special regard to external rotation in adduction (AddER) and abduction (AbdER). Besides, the Constant-Murley score and Subjective Shoulder Value (SSV) were evaluated before a plate removal and after a minimum two-year follow-up after the surgery.ResultsDeltoid adhesion release correlated with considerable and statistically significant improvement of AddER (p < 0.0002) but not with the intraoperative range of AbdER. Significant improvement of AddER, but also of AbdER and other range of motion was noted at the follow-up. The improvement of the affected shoulder function following arthroscopic plate removal was considerable and statistically significant according to the modified Constant-Murley score (p < 0,01) and SSV (p < 0.0000) after a minimum of two-year follow-up.ConclusionsOur findings are the first to highlight the influence of deltoid muscle, plate, and humerus adhesions on limiting external rotation in adduction after ORIF treatment of proximal humerus fractures. These observations allow the identification of a new shoulder evaluation symptom: Selective Glenohumeral External Rotation Deficit (SGERD) as well as functional deltohumeral space.
Highlights
The deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture
The implant removals have been required in 50.6% of cases after minimally-invasive plate osteosynthesis (MIPO); of these, 67.5% of cases were due to an implant-related irritation [1]
Many works confirm that the ROM of the shoulder improves after open or arthroscopic removal of the plate, none discuss the role of adhesions between the deltoid and the plate, or the proximal end of the humerus, concerning their potential impact on the range of motion, especially the external rotation of the shoulder set at adduction [8, 9]
Summary
The deltopectoral approach is commonly used for plate stabilization of proximal humerus fracture. Adhesions between the deltoid, plate, and humerus are common sequelae of plate ORIF, little is known about their effect on the range of movement and a function of the shoulder To confirm their impact, the preoperative and intraoperative evaluation of the range of motion (ROM) was measured during the sequential arthroscopic release of adhesions, with special regard to external rotation. Many works confirm that the ROM of the shoulder improves after open or arthroscopic removal of the plate, none discuss the role of adhesions between the deltoid and the plate, or the proximal end of the humerus, concerning their potential impact on the range of motion, especially the external rotation of the shoulder set at adduction [8, 9]
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