Minimally Invasive Application of the Non-Contact-Bridging (NCB) Plate to the Proximal Humerus: An Anatomical Study

Röderer, Götz; AbouElsoud, Maged; Gebhard, Florian; Böckers, Tobias M.; Kinzl, L.

doi:10.1097/bot.0b013e318157f0cd

Cited by 40 publications

(23 citation statements)

References 21 publications

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“…The ADLs at 6 weeks postoperatively were similar and increased for all groups over time ( Table 4). The average ADL reached 18 (95% CI, [17][18][19][20] for the deltoid-split and 17 (95% CI, [14][15][16][17][18][19] for the deltopectoral group 12 month after operation (p = 0.31).…”

Section: Functionmentioning

confidence: 99%

“…As an alternative, a less invasive, deltoid- split approach has been described with the goal of minimizing local soft tissue trauma. Early results with this approach have been shared [16,18], although only a few nonrandomized trials have compared the two approaches [11,17,22]. In light of the deficiencies in the existing evidence base, we initiated a randomized controlled trial.…”

Section: Introductionmentioning

confidence: 99%

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Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Questions/purposes In this prospective randomized study, we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to (1) complication rate; (2) shoulder function (Constant score); and (3) pain (visual analog scale [VAS]) for internal fixation of displaced humeral fractures with a polyaxial locking plate.Methods We randomized 120 patients with proximal humeral fractures to receive one of these two approaches (60 patients for each approach). We prospectively documented demographic and perioperative data (sex, age, fracture type, hospital stay, operation time, and fluoroscopy time) as well as complications. Followup examinations were conducted at 6 weeks, 6 months, and 12 months postoperatively, including radiological and clinical evaluations (Constant score, activities of daily living, and pain [VAS]). Baseline and perioperative data were comparable for both approaches. The sample size was chosen to provide 80% power, but it reached only 68% as a result of the loss of followups to detect a 10-point difference on the Constant score, which we considered the minimum clinically important difference. Results Complications or reoperations between the approaches were not different. Eight patients in the deltoid-split group (14%) needed surgical revisions compared with seven patients in the deltopectoral group (13%; p = 1.00). Deltoid-split and deltopectoral approaches showed similar Constant scores 12 months postoperatively (Deltoid-split 81; 95% confidence interval [CI], 74-87 versus deltopectoral 73; 95% CI, 64-81; p = 0.13), and there were no differences between the groups in terms of pain at 1 year (deltoid-split 1.8; 95% CI, 1.2-1.4 versus deltopectoral 2.5; 95% CI, 1.7-3.2; p = 0.14). No learning-curve effects were noted; fluoroscopy use during surgery and function and pain scores during followups were similar among the first 30 patients and the next 30 patients treated in each group. Conclusions The treatment of proximal humeral fractures with a polyaxial locking plate is reliable using both approaches. For a definitive recommendation for one of these approaches, further studies with appropriate sample size are necessary.

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Section: Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Second, after the stab incision in the skin, blunt dissection down to the plate is performed with scissors. Third, an oscillating drill technique is used [18].…”

Section: Implant and Surgical Techniquementioning

confidence: 99%

“…For the open surgical technique, open reduction and internal fixation (ORIF) is performed using a standard deltopectoral approach. The MI technique uses a deltoid split approach starting at the anterolateral acromion [18]. Fracture reduction is performed percutaneously as described previously [17,20].…”

Section: Implant and Surgical Techniquementioning

confidence: 99%

“…The system allows both open and minimally invasive (MI) application. Early clinical results in smaller populations have been promising [18,19]. The objective of this prospective, multicentre study was to investigate the clinical outcome and complication rate of this device in a bigger population and to analyse the influence of the open and MI surgical techniques on the results.…”

Section: Introductionmentioning

confidence: 99%

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Second generation locked plating of proximal humerus fractures—A prospective multicentre observational study

Röderer

Erhardt

Kuster

et al. 2010

International Orthopaedics (SICOT)

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Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis. Locking plates are intended to provide superior mechanical stability. In a prospective multicentre study 131 patients were treated with second generation locked plating (NCB-PH, Zimmer, Inc.). The open procedure (n=78) was performed using a deltopectoral approach; the minimally invasive technique (n=53) involved percutaneous reduction and an anterolateral deltoid split approach. Clinical and radiological follow-up was obtained. Improvement in function (ROM) was statistically significant. Fracture type (AO) had the most significant impact on the incidence of complications. The most frequent complications detected were intra-articular screw perforation (15%) and secondary displacement (8%). Complication rate and functional outcome of the NCB-PH are comparable to reports in the literature. Not all problems are likely to be solved by this new generation of implants, i.e. secondary dislocation still occurred in 8% of our patients.

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Intraoperative Considerations

Siebenlist¹

2015

Strategies in Fracture Treatments

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Minimally Invasive Application of the Non-Contact-Bridging (NCB) Plate to the Proximal Humerus: An Anatomical Study

Cited by 40 publications

References 21 publications

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Second generation locked plating of proximal humerus fractures—A prospective multicentre observational study

Intraoperative Considerations

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