MIPO of proximal humerus fractures through an anterolateral acromial approach. Is the axillary nerve at risk?

Knežević, Josip; Mihalj, Mario; Čukelj, Fabijan; Ivanišević, Arsen

doi:10.1016/s0020-1383(17)30733-7

Cited by 9 publications

(6 citation statements)

References 42 publications

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“…Then, a two-incision minimally invasive anterolateral approach was used to fix the lateral fracture of the proximal humerus as previously reported [12]. A locking plate of appropriate length was inserted from the proximal incision to the distal portion of the fracture along the lateral aspect of the humerus.…”

Section: Patients Surgical Techniques and Clinical Resultsmentioning

confidence: 99%

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

Dong

et al. 2021

J Orthop Surg Res

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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 We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same 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° 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.

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Section: Patients Surgical Techniques and Clinical Resultsmentioning

confidence: 99%

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

Dong

et al. 2021

J Orthop Surg Res

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show abstract

“…Then, a two-incision minimally invasive anterolateral approach was used to x the lateral fracture of the proximal humerus as previously reported [12]. A locking plate of appropriate length was inserted from the proximal incision to the distal portion of the fracture along the lateral aspect of the humerus.…”

Section: Patients Surgical Techniques and Clinical Resultsmentioning

confidence: 99%

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

Wang²,

Dong

et al. 2020

Preprint

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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

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“…On the other hand, the effect of the calcar screws on the fracture stability has been emphasized in most studies (20). Furthermore, some authors recommended avoiding calcar screws in terms of the risk of axillary nerve damage (21). However, Shin et al (22) reported that the modified deltoid split approach with axillary nerve mobilization yielded excellent outcomes.…”

Section: Discussionmentioning

confidence: 99%

Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results

Okutan

2022

Journal of Health Sciences and Medicine

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Aim: We aimed to present deltoid split approach under traction in lateral decubitus position that we perform for the treatment of proximal humerus fractures (PHFs) and to present the preliminary surgical and clinical outcomes of our patients. Material and Method: Twelve patients who underwent plate osteosynthesis through a deltoid split approach under traction in lateral decubitus position between May 2019 and January 2021 were evaluated. Patient demographics, Neer classification, and time from injury to surgery were collected in all patients preoperatively. Radiation exposure time and operating time was recorded intraoperatively. Radiological outcomes were assessed, including time to union, and neck-shaft angle. Functional outcomes were evaluated using the Constant score at the minimum 12-month follow-up. Results: Twelve patients (5 male, 7 female) were evaluated with a mean age 58.6±10.7 years (range, 32 to 72 years) at the time of surgery. The mean follow-up period was 117.4±3.8 months). The mean operation time was 60.7±15.2 min (range, 44 to 92 min). The mean radiation exposure time was 6.1±3.0 s (range, 3.3 to 14.2 s). Fracture union was observed in all patients at mean 14.6±2.5 weeks (range, 8 to 20 weeks). The mean neck-shaft angle after the union was 134.5±3.4 degrees (range, 124 to 143 degrees). The mean Constant score was at the final follow-up was 76.4±8.7 (range, 63 to 90). Conclusion: Patient positioning in the lateral decubitus position under traction can be considered as a safe, reliable, and reproducible method in selected patients with PHFs.

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MIPO of proximal humerus fractures through an anterolateral acromial approach. Is the axillary nerve at risk?

Cited by 9 publications

References 42 publications

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

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

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

Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results

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