Minimally Invasive Polyaxial Locking Plate Fixation of Proximal Humeral Fractures: A Prospective Study

Ruchholtz, Steffen; Hauk, Carsten; Lewan, Ulrike; Franz, Daniel; Kühne, Christian; Zettl, Ralph

doi:10.1097/ta.0b013e31823f62e4

Cited by 42 publications

(40 citation statements)

References 20 publications

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“…The small rate of complications in our study (14% deltoid split; 13% deltopectoral) may be explained by the fact that three experienced surgeons performed the osteosynthesis. Our previous study about the surgical technique for the less invasive approach showed 16.3% complications; the rate of complications seems to be highly associated with the experience of the surgeon [18]. This assumption is underlined by the fact that patients enrolled early in this study showed comparable clinical outcomes compared with patients enrolled late in this study (Table 3).…”

Section: Discussionmentioning

confidence: 51%

“…To protect the axillary nerve, we indicated the nerve with the index finger in the subdeltoid bursa and its course was marked on the skin. Additionally, we used a five-hole plate that was inserted with its tip contacting the bone, and we fixed screws in the three distal holes, far away from the axillary nerve [18]. A similar technique is described by Acklin et al [1]; like us, they saw no injury to the axillary nerve in clinical observation.…”

Section: Discussionmentioning

confidence: 75%

“…The step-by-step explanation of the surgical technique was previously described by our working group [18].…”

Section: Deltoid-split Approachmentioning

confidence: 99%

“…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: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 75%

“…The step-by-step explanation of the surgical technique was previously described by our working group [18].…”

Section: Deltoid-split Approachmentioning

confidence: 99%

Section: Functionmentioning

confidence: 99%

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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ESTES recommendations on proximal humerus fractures in the elderly

Wendt

Jaeger

Verbruggen

et al. 2020

Eur J Trauma Emerg Surg

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PurposeThe section for the skeletal trauma and sport's injuries of the European Society for Trauma and Emergency Surgery (ESTES) appointed a task force group to reach a consensus among European countries on proximal humeral fractures. Material/Methods The task force group organized several consensus meetings until a paper with final recommendations was confirmed during the ESTES Executive Board meeting in Berlin on 25 October 2018. ConclusionThe Recommendations compare conservative and four possible operative treatment options (ORIF, nailing, hemi-and total reverse arthroplasty) and enable the smallest common denominator for the surgical treatment among ESTES members.

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Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study

Falez

Papalia

Greco

et al. 2015

International Orthopaedics (SICOT)

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Minimally Invasive Polyaxial Locking Plate Fixation of Proximal Humeral Fractures: A Prospective Study

Abstract: MIS surgery of displaced humeral head fractures can be performed in all types of humeral head fractures leading to low complication rates and good clinical outcome. A standardized stepwise procedure in fracture reduction and fixation is recommended to achieve reliable good results.

Cited by 42 publications

References 20 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?

ESTES recommendations on proximal humerus fractures in the elderly

Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study

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