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

Abstract

Background and hypothesis: The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and Methods: An anatomical study was performed and an anatomical medial locking proximal humerus plate was designed based on the measurement results. Between November 2014 and April 2017, eight cases of proximal humerus fractures with unstable medial columns underwent medial fixation. All surgeries were performed by a single surgeon. Patients were followed clinically and radiographically at 1, 3, 6 and 12 months postoperatively.Results: There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10 degrees in any direction), screw cutout, nonunion, or deep infection occurred.Conclusions: The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.Level of evidence: Retrospective Study

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

“…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.…”

“…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.…”

Application of a lateral intertubercular sulcus plate in the treatment of proximal humeral fractures: A finite element analysis and example in clinical practice

“…A comparative study by Shen et al [17] reported that placement of the medial support screw greatly reduced screw cutting, varus deformity, and the probability of a secondary surgery. In clinical practice, various methods such as autologous or allogeneic fibula implantation, titanium mesh implantation, and the use of an auxiliary steel plate are used to compensate for the effect of the medial support screw and strengthen medial support [7][8][9][10][11].…”

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

Observation on the Effect of Minimally Invasive Technique in Clinical Treatment of Orthopaedic Trauma

“…The total effective rate was calculated as follows: Total effective rate = (significant effect + effective)/ total number of columns *100%. [2] We compared the clinical indicators of patients in the two groups, including dressing change times, wound healing time, blood loss during operation time, quality of life score and pain score, etc. The higher the quality of life score, the better the patient's quality of life.…”