The Functional Outcome of Direct Lateral Approach For Fixation Of Proximal Humeral Fractures, case series from a Tertiary Care Hospital

Mujahid Khattak,Muhammed Saleem,Ahmed Khan,Mohammad Khan,Irfan Anwer

doi:10.5455/jpma.300885.

Abstract

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow fractures were excluded. Oxford Shoulder Score was done at regular intervals for assessment of functional outcome. We did not observe any axillary nerve damage in our case series and the outcomes of 70.5% of our patients were excellent while in 29.5% it was good. We recommend direct lateral approach for specific pattern of proximal humerus fractures.

Highlights

Proximal humeral fractures account for more than 50% percent of all humeral fractures and 5-6% of all fractures in adults.[1]
Direct lateral Deltoid splitting approach helps in direct reduction of posterolateral displaced tuberosity fragments and is less time consuming as the plate can be applied
We report our series of patients with proximal humerus fractures who underwent fixation with direct lateral trans deltoid approach at the Aga Khan University Hospital, Karachi

Summary

Introduction

Proximal humeral fractures account for more than 50% percent of all humeral fractures and 5-6% of all fractures in adults.[1]. We report our series of patients with proximal humerus fractures who underwent fixation with direct lateral trans deltoid approach at the Aga Khan University Hospital, Karachi. The objective of our study is to assess the functional outcomes and morbidity associated with Direct Lateral trans-deltoid approach in proximal humerus fractures in our series. This is a retrospective study of 17cases of proximal humerus fractures. PHILOS plate was applied laterally by sliding underneath the Figure-1: Patient in Beach-Chair position for right sided Humeral fracture, landmarks are identified, and after the incision, distance is measured from the acromion to protect the axillary nerve. There was no case of non-union, infection or varus malunion and/or acromion impingement

Discussion

Findings

Conclusion