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An Anterosuperior Deltoid Splitting Approach for Plate Fixation of Proximal Humeral Fractures

  • Shin, Dong-Ju (Department of Orthopedic Surgery, Daegu Fatima Hospital) ;
  • Byun, Young-Soo (Department of Orthopedic Surgery, Daegu Fatima Hospital) ;
  • Cho, Young-Ho (Department of Orthopedic Surgery, Daegu Fatima Hospital) ;
  • Park, Ki-Hong (Department of Orthopedic Surgery, Daegu Fatima Hospital) ;
  • Yoo, Hyun-Seong (Department of Orthopedic Surgery, Daegu Fatima Hospital)
  • 투고 : 2014.07.29
  • 심사 : 2014.10.28
  • 발행 : 2015.03.30

초록

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.

키워드

참고문헌

  1. Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18(3 Suppl):209S-13S. https://doi.org/10.1016/8756-3282(95)00504-8
  2. Depalma AF, Cautilli RA. Fractures of the upper end of the humerus. Clin Orthop. 1961;20:73-93.
  3. Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury. 2007;38 Suppl 3:S59-68. https://doi.org/10.1016/j.injury.2007.08.013
  4. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52(6):1090-103.
  5. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4.
  6. Tae SK, Rhee YG, Park TS, et al. The development and validation of an appraisal method for rotator cuff disorders: the Korean Shoulder Scoring System. J Shoulder Elb Surg. 2009; 18(5):689-96. https://doi.org/10.1016/j.jse.2008.11.019
  7. Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand. 1986;57(4):320-3. https://doi.org/10.3109/17453678608994401
  8. Traxler H, Surd R, Laminger KA, Windisch A, Sora MC, Firbas W. The treatment of subcapital humerus fracture with dynamic helix wire and the risk of concommitant lesion of the axillary nerve. Clin Anat. 2001;14(6):418-23. https://doi.org/10.1002/ca.1077
  9. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14(3):162-6. https://doi.org/10.1097/00005131-200003000-00002
  10. Livani B, Belangero WD. Bridging plate osteosynthesis of humeral shaft fractures. Injury. 2004;35(6):587-95. https://doi.org/10.1016/j.injury.2003.12.003
  11. Zhiquan A, Bingfang Z, Yeming W, Chi Z, Peiyan H. Minimally invasive plating osteosynthesis (MIPO) of middle and distal third humeral shaft fractures. J Orthop Trauma. 2007;21(9):628-33. https://doi.org/10.1097/BOT.0b013e31815928c2
  12. Bathis H, Tingart M, Bouillon B, Tiling T. Surgical treatment of proximal humeral fractures. Is the T-plate still adequate osteosynthesis procedure? Zentralbl Chir. 2001;126(3):211-6. https://doi.org/10.1055/s-2001-12498
  13. Gardner MJ, Griffith MH, Dines JS, Briggs SM, Weiland AJ, Lorich DG. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus. Clin Orthop Relat Res. 2005;(434):123-9.
  14. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22(3):159-64. https://doi.org/10.1097/BOT.0b013e318169ef2a
  15. Blum J, Rommens PM. Proximal interlocking of humeral intramedullary nails and risk of axillary nerve injury. Unfallchirurg. 2002;105(1):9-13. https://doi.org/10.1007/s113-002-8158-5
  16. Rommens PM, Blum J, Runkel M. Retrograde nailing of humeral shaft fractures. Clin Orthop Relat Res. 1998;(350):26-39.
  17. Hepp P, Theopold J, Voigt C, Engel T, Josten C, Lill H. The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. J Shoulder Elb Surg. 2008;17(1):21-8. https://doi.org/10.1016/j.jse.2007.03.029
  18. Lill H, Hepp P, Rose T, Konig K, Josten C. The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach-technique and first results. Zentralbl Chir. 2004;129(1):43-8. https://doi.org/10.1055/s-2004-44870
  19. Apaydin N, Uz A, Bozkurt M, Elhan A. The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder. Clin Anat. 2007;20(3):273-7. https://doi.org/10.1002/ca.20361
  20. Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd. Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res. 2000;(373):259-64.
  21. Abbott LC, Dec J, Saunders JB, et al. Surgical approaches to the shoulder joint. J Bone Joint Surg Am. 1949;31(2):235-55. https://doi.org/10.2106/00004623-194931020-00002
  22. Burkhead WZ Jr, Scheinberg RR, Box G. Surgical anatomy of the axillary nerve. J Shoulder Elb Surg. 1992;1(1):31-6. https://doi.org/10.1016/S1058-2746(09)80014-1
  23. Kontakis GM, Steriopoulos K, Damilakis J, Michalodimitrakis E. The position of the axillary nerve in the deltoid muscle. A cadaveric study. Acta Orthop Scand. 1999;70(1):9-11. https://doi.org/10.3109/17453679909000948
  24. Abhinav G, Sivaraman B, Matthew N, Grahame JST. A contribution to the calculation of a safe deltoid split. Int J Shoulder Surg. 2008;2(3):52-5. https://doi.org/10.4103/0973-6042.42577
  25. Lin T, Xiao B, Ma X, Fu D, Yang S. Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures. BMC Musculoskelet Disord. 2014;15:206. https://doi.org/10.1186/1471-2474-15-206