Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

Korkmaz, Medet

doi:10.5505/tjtes.2015.74150

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…In contrast, an approach from the lateral side provides a convenient access to the displaced fragments and also for plate fixation on Section: Orthopaedics the lateral surface. [23] Many recent studies have shown excellent functional results with the lateral approach, whether extended or minimal, with no incidence of any axillary nerve palsy or any other significant complications. [14,24] In fact, most studies involving comparison of the functional results between the deltopectoral and deltoid splitting approaches have come out with better functional scores using the deltoid splitting approach.…”

Section: Discussionmentioning

confidence: 98%

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature

Kohli¹,

Vishwakarma²,

Chauhan³

et al. 2016

AIMDR

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Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries and elevates the risk of bleeding.

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Section: Discussionmentioning

confidence: 98%

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature

Kohli¹,

Vishwakarma²,

Chauhan³

et al. 2016

AIMDR

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“…In contrast, an approach from the lateral side provides a convenient access to the displaced fragments and also for plate fixation on the lateral surface. 6 Many recent studies have shown excellent functional results with the lateral approach, whether extended or minimal, with no incidence of any axillary nerve palsy or any other significant complications. 7,15 In fact, most studies involving comparison of the functional results between the deltopectoral and deltoid splitting approaches have come out with better functional scores using the deltoid splitting approach.…”

Section: Discussionmentioning

confidence: 99%

“…The transdeltoid or the deltoid splitting approach obviates some of these disadvantages of the deltopectoral approach and provides convenient access to the lateral surface of the proximal humerus. 2,[5][6][7] But there have been concerns regarding the use of deltoid splitting approach due to the potential of injury to the axillary nerve that traverses around the surgical neck of humerus, through the substance of the deltoid; and also because of the fact that splitting the deltoid could result in weakening of this muscle and resultant difficulty in shoulder movements, particularly abduction.…”

Section: Introductionmentioning

confidence: 99%

Lateral transdeltoid approach to proximal humerus fractures

2015

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INTRODUCTIONFractures of the proximal humerus are the most common fractures of this bone and constitute 5-6% of the total fracture incidence in adults; and this incidence increases with age.1 Complex fractures of the proximal humerus are often difficult to treat and result in considerable shoulder dysfunction unless adequately treated.2 According to the Neer's criteria for the proximal humerus fractures, fractures with fragments separated more than 1 cm or with more than 45 degree angulation are considered as displaced fractures; 3,4 and hence need open reduction and internal fixation. Most of the surgeons are familiar with the traditional deltopectoral approach, which utilizes the internervous plane between the pectoralis major and the deltoid; and hence this is the most commonly used approach for proximal humerus fracture fixation. 2 But in certain fractures in which the fragments especially the greater tuberosity fragment is displaced, usually posterolaterally, reduction through this approach is difficult. In addition, the application of plates on the lateral surface of proximal humerus requires a lot of soft tissue dissection and retraction. Hence an access from the lateral aspect would be far more convenient in certain circumstances. The transdeltoid or the deltoid splitting ABSTRACT Background: The deltopectoral approach is the most commonly used approach for the reduction and fixation of proximal humerus fractures. But it provides inadequate access to the posteriorly displaced fragments in comminuted fractures and to the lateral surface where the plate is to be applied. These disadvantages can be obviated by a direct lateral transdeltoid approach. There have been concerns regarding postoperative axillary nerve palsy and deltoid dysfunction with this approach. This study had been conceptualized to assess the outcome of fixation of proximal humerus fractures with deltoid splitting lateral approach. Methods: A total of 20 patients with Neer's type 2 and 3 fractures of proximal humerus were included in this study. Lateral transdeltoid approach was used for exposure, with either an extended incision or a "two window" less invasive incision, depending upon the fracture anatomy. Functional outcome was assessed using the Constant Murley shoulder score. Results: The fracture was classified as Neer's type 2 in 30% and type 3 in 70% of the cases. The mean Constant Murley score at final follow up was 78 (range 64-84). Graded according to the Constant shoulder score grading criteria, the results were excellent in 60%, good in 35% and fair in 5% of the cases. No case of postoperative axillary nerve palsy was encountered. Conclusions: The functional outcome was either excellent or good in 95% of the cases and no case of axillary nerve palsy was seen. Hence, Lateral transdeltoid approach is a convenient and useful approach to proximal humerus fractures.

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“…4 The 2 most common open surgical approaches for greater tuberosity fractures are the deltopectoral approach or the directelateral deltoid-splitting approach. 5 Although considerable debate remains on the most optimal of these 2 approaches for more complicated fracture patterns, an all-arthroscopic technique has been employed for isolated, displaced greater tuberosity fractures. Multiple different techniques for fixation of greater tuberosity fractures have been reported, including screw fixation, single-and double-row anchor fixation, and bridging constructs.…”

mentioning

confidence: 99%

Arthroscopic Reduction and Internal Fixation of Proximal Humerus Greater Tuberosity Fracture

Patel

Nuelle

Hartzler

2020

Arthroscopy Techniques

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Proximal humerus fractures are common fractures that may occur after ground level falls or other traumatic events resulting in a direct injury to the shoulder. Depending on the fracture morphology and the age of the patient, anatomic reduction can vastly improve outcomes, especially in fracture patterns that involve the greater tuberosity. In this case example, we performed a minimally invasive, arthroscopic reduction and fixation of a proximal humerus fracture that involved significant displacement of the greater tuberosity. The technique employed is reproducible and avoids the morbidity of a large open incision while simultaneously providing compression of the fracture fragment for excellent healing potential.

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Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

Cited by 3 publications

References 21 publications

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature

Transdeltoid Approach in Proximal Humerus Fractures: Outcome in 35 Cases and Review of Literature

Lateral transdeltoid approach to proximal humerus fractures

Arthroscopic Reduction and Internal Fixation of Proximal Humerus Greater Tuberosity Fracture

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