A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Wang, Fu; Wang, Yan; Dong, Jinye; He, Yu; Li, Lianxin; Liu, Fanxiao; Dong, Jinlei

doi:10.1186/s13018-020-02094-7

Cited by 8 publications

(14 citation statements)

References 34 publications

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“…In another quantitative assessment of the vascularity, PCHA provided 64% of the blood supply while the ACHA only supply 36% [27]. First, the small diameter of the ACHA (0.3mm-2mm) in comparison to that of the PCHA (1.2-5.5mm) is also funded by other studies [24,26,28]. Second, in clinical study of treatment for complex PHFs, no intact ACHA were found in 16 cases except 1 patient But successful fracture healing was achieved in all 17 cases [29].…”

Section: Discussionmentioning

confidence: 93%

“…The medial plate provided a rm buttress. Good prognosis has been obtained in both biomechanical evaluation and clinical practice in our institution [23,24]. However, some experts believe that the medial approach will sacri ce the ACHA.…”

Section: Introductionmentioning

confidence: 83%

“…The upper limbs were placed with the arm abducted to 60 degrees on average in supine position. All specimens have been dissected through a medial incision to expose the shoulder joint [24]. The insertion of the pectoralis major tendon onto the humerus was transected and re ected for better visualization.…”

Section: Methodsmentioning

confidence: 99%

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Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Xiang

Wang

Yang

et al. 2021

Preprint

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Background: The treatment of complex 3- and 4- part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.Method: Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.Results: Medial plate can be easily placed in 86.84% anatomical patterns. An interval of 2 to 3cm (24.29 ± 3.42 mm) was available for internal fixation. ACHA (49.35 ± 8.13 mm, 35.14 - 68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67 - 66.76 mm) were about 5cm away from the coracoid process. Risk factors including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels; musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk factor should be taken seriously. Conclusion: The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 83%

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Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Xiang

Wang

Yang

et al. 2021

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“…A comparative study by Shen et al [17] reported that placement of the medial support screw greatly reduced the screw cutting, varus deformity, and the probability of secondary surgery. Various methods are used to compensate for the effect of the medial support screw and strengthen medial support in clinical practice, such as autologous or allogeneic fibula implantation, titanium mesh implantation, and the use of an auxiliary steel plate [7][8][9][10][11]. The selection, treatment, and placement of fibula grafts and titanium mesh require high technical experience among orthopedic doctors.…”

Section: Discussionmentioning

confidence: 99%

“…There are several methods for strengthening medial support in clinical practice, such as allograft fibula implantation [7], titanium mesh implantation [8], bone cement [9], and auxiliary support plates [10][11]. In clinical practice, the authors have used a 1/3 tubular steel plate as an auxiliary plate to develop the shape according to the lateral anatomical structure of the internodal sulcus, placing it on the outside of the internodal sulcus.…”

mentioning

confidence: 99%

Application of a Lateral Intertubercular Sulcus Plate in the Treatment of Proximal Humeral Fractures: a Finite Element Analysis and Example in Clinical Practice

Liu¹,

Lv²,

Chen³

et al. 2021

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Background: Inversion deformities caused by insufficient medial support are especially common when the PHILOS locking plate is used to treat proximal humeral fractures. Using finite element analysis, the present study aimed to compare the biomechanical properties of a PHILOS locking plate (PLP) and a PHILOS plate combined with a lateral intertubercular sulcus plate (PLP-LSP) in the fixation of proximal humeral fractures with loss of the medial column. We also present representative results for a 69-year-old female patient with a comminuted fracture of the proximal right humerus (Neer type four-part fracture) who underwent successful surgical treatment with a PHILOS plate combined with an auxiliary lateral intertubercular sulcus plate. Methods: After creating a three-dimensional finite element model of proximal humeral fracture with loss of the medial column, three implant models were established. A full-screw PHILOS plate (PLP) was used in Group A, while a PHILOS plate lacking medial screw support and an auxiliary plate were used in Group B (MPLP-LSP). A full-screw PHILOS plate and auxiliary plate were used in Group C (PLP-LSP). The three fixation models were applied to the proximal humerus fracture model, following which horizontal, compressive, and rotational loads were applied to the humerus model. We evaluated the structural stiffness and stress distribution of the implant and compared displacement and angle changes among the three models. Results: Displacement and angle changes were smallest in Group C (PLP-LSP). The implant model used in Group C also had the highest structural rigidity, endured less von Misses stress than the other two models , and had the strongest stability. In our clinical case, X-ray and computed tomography images obtained 3 months after the operation indicated that the fracture had healed, with good positioning of internal fixation and good functional recovery.Conclusion: A lateral intertubercular sulcus plate placed at the internodal grove not only aids in anatomical reduction but also provides effective lateral and medial support, thereby reducing stress on the PHILOS plate and providing better stability in patients with proximal humeral fractures.

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Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach

Wang,

Zhao,

Liu

et al. 2024

JOIO

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Background The reduction and fixation of Medial humeral calcar is difficult in the treatment of elderly proximal humerus Neer 3 and 4-part fractures with a single lateral locking plate. Our study investigated the efficacy of an intramedullary calcar supporting plate combined with a lateral locking plate for the treatment of 3- and 4-part fractures of the proximal humerus in the elderly through a deltoid splitting approach. Methods From June 2022 to December 2022, we treated six elderly patients with Neer 3 and 4-part fractures using proximal humeral intramedullary calcar support plate in combination with lateral locking plate through a deltoid splitting approach. Follow-up time was 6–12 months. Assessment indicators included fracture union, quality of reduction, and complication rate. The Constant-Murley score was used to record shoulder function at 6 months postoperatively. Results All 6 patients showed fracture union and anatomic reduction. Constant-Murley score was 79.5 (70–90) at 6 months postoperatively. There was no incision non-healing, internal fixation failure, bone non-union or surgical site infection, secondary surgery, or death. Shoulder impingement occurred in 1 case. Conclusion Proximal humeral intramedullary calcar support plate combined with lateral locking plate fixation through a deltoid splitting approach can effectively maintain fracture reduction, prevent inversion collapse of humeral head and internal fixation failure, and provide satisfactory clinical results at an early stage.

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A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

Cited by 8 publications

References 34 publications

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

Application of a Lateral Intertubercular Sulcus Plate in the Treatment of Proximal Humeral Fractures: a Finite Element Analysis and Example in Clinical Practice

Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach

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