Surgical Exposures of the Humerus

Zlotolow, Dan A.; Catalano, Louis W.; Barron, Alton O.; Glickel, Steven Z.

doi:10.5435/00124635-200612000-00007

Cited by 138 publications

(72 citation statements)

References 19 publications

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“…The deltopectoral approach is regarded as the standard for proximal humeral shaft fractures [13] as it provides adequate exposure for internal fixation. Concern about using the approach centres on potential damage to the radial nerve.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Zhou

Gao

Tang

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach. Methods Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function. Results No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients. Conclusions Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Zhou

Gao

Tang

et al. 2012

International Orthopaedics (SICOT)

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“…The anterolateral exposure utilizing the deltopectoral interval with extension down the arm through a brachialis split provides excellent exposure to the proximal diaphysis. Distal extension is limited by the radial nerve piercing the lateral intermuscular septum [13]. Posterior approaches facilitate exposure of distal third fractures and can be extended proximally with mobilization of the radial nerve from the spiral groove.…”

Section: Operative Management Of Humeral Shaft Fracturesmentioning

confidence: 99%

“…About 10-14 cm from the lateral acromion, the nerve and artery travel along the posterior humerus in the spiral groove, separating the medial and lateral heads of the triceps at about the level of the deltoid tuberosity. It enters the anterior compartment though the lateral intermuscular septum approximately 10 cm from the distal articular surface, here it is tightly bound by the septum and therefore susceptible to traction injuries and radial nerve palsies [12,13].…”

mentioning

confidence: 99%

Humeral shaft fractures

Spiguel

Steffner

2012

Curr Rev Musculoskelet Med

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Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

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“…[10][11][12] The posterior and anterolateral approaches are the most frequently used because they allow access to a larger segment of the humerus. The lateral approach is used for the distal quarter of the humerus.…”

mentioning

confidence: 99%

“…The lateral approach is used for the distal quarter of the humerus. 7,8,[10][11][12][13] Surgical treatment carries specific risks related to the close anatomic relationships among the bone, nerves and blood vessels. Iatrogenic injury of the radial nerve occurs in 10%-25% of patients as a result of contusion, stretch or direct damage.…”

mentioning

confidence: 99%

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

Boschi

Pogorelić²,

Gulan³

et al. 2013

Can J Surg

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RESEARCH • RECHERCHE Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series studyBackground: There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. Methods:We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used.Results: During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. Conclusion:The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves. Contexte :Il existe peu d'approches chirurgicales pour corriger la fracture de la diaphyse humérale. Nous présentons ici les résultats que nous avons obtenus avec une approche sous-brachiale.Méthodes : Nous avons réalisé une série de cas rétrospective regroupant des patients ayant subi une chirurgie pour réparation de fracture de la diaphyse humérale entre janvier 1994 et janvier 2008. Nous avons divisé les patients en 4 groupes selon l'approche chirurgicale employée (antérieure, antérolatérale, postérieure et sousbrachiale). Nous avons utilisé une plaque de compression dynamique AO de 4,5 mm.Résultats : Pendant la période de l'étude, 280 patients de 30 à 36 ans ont subi une chirurgie pour fracture de la diaphyse humérale. La durée moyenne de la chirurgie a été la plus courte avec l'approche sous-brachiale (40 min). La perte moyenne de force musculaire a été de 40 %, 48 %, 42 % et 20 % avec les approches antérolatérale, postérieure, antérieure et sous-brachiale, respectivement. La perte moyenne de tension dans le muscle brachial après 4 mois était respectivement de 61 %, 48 %, et 11 % avec les approches antérolatérale, antérieure et sous-brachiale. Seize patients des groupes soumis aux approches antérolatérale et antérieure et 6 patients du groupe soumis à l'approche postérieure ont subi des lésions peropératoires du nerf radial. Aucune complication postopératoire n'a été observée dans...

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Surgical Exposures of the Humerus

Cited by 138 publications

References 19 publications

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Humeral shaft fractures

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

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