The Extended Anterolateral Acromial Approach Allows Minimally Invasive Access to the Proximal Humerus

Gardner, Michael J.; Griffith, Matthew H.; Dines, Joshua S.; Briggs, Stephen; Weiland, Andrew J.; Lorich, Dean G.

doi:10.1097/01.blo.0000152872.95806.09

Cited by 144 publications

(113 citation statements)

References 24 publications

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“…However, by contrast, it is seen commonly when the delta-split approach is employed, when there are concerns regarding injury to the axillary nerve with subsequent dysfunction of the anterior deltoid [15,16]. Although in a recent study injury to the axillary nerve was not observed, the axillary nerve is in danger according to previous studies [17].…”

Section: Discussionmentioning

confidence: 95%

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: 95%

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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“…However, some authors have argued that this approach involves extensive soft tissue dissection and muscle retraction to gain adequate exposure to the lateral aspect of the humerus [9]. As an alternative, a less invasive, deltoid- split approach has been described with the goal of minimizing local soft tissue trauma.…”

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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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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“…Sinirin yaklaşık 20 derecelik superior oblik açısı ve fibröz bandı geçtiği yerdeki kalınlığı, siniri tanımlarken cerraha ne bekleyebileceği konusunda genel bir fikir vermektedir. [21] Mackenzie sinirin yaralanma potansiyelinden kaçınmak için akromionun lateral köşesinden 6 cm'den daha fazla distalde olmayacak ve sonrada durdurucu sütür ile deltoid splitting tariflemiştir. [22] Flatow ve Bigliani sinir lokalizasyonu için tug testini tariflemişlerdir.…”

Section: Discussionunclassified

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

Korkmaz¹

2015

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Proksimal humerus kırıkları sık görülen ve fonksiyonel kısıtlanmaya neden olan kırıklardandır. Bu geriye dönük çalışmanın amacı aynı fiksasyon metodu kullanılarak deltopektoral ile deltoid split girişimin karşılaştırılmasıdır. GEREÇ VE YÖNTEM: BULGULAR:Lateral deltoid split girişim kullanılan olgularda baş ve tüberküler fragman redüksiyonunun daha iyi olduğu ve Constant omuz skorunun erken dönemde daha yüksek olduğu saptandı (sırasıyla, 66.8-57.4; p<0.01). Aksiller sinir gözlenip askıya alındığı için bu sinire ait komplikasyon saptanmadı. Altıncı aydaki Constant skorları arasında anlamlı farklılık saptanmadı (sırasıyla, 92.2-91.3; p>0.05). SONUÇ:Deltoid split girişim, özellikle AO/ASİF B ve C tipi kırıklarda proksimal humerusun 270 derece kontrolüne, tüberküler parçalardan ve döndürücü manşet tendonlarından geçirilen dikişlerle redüksiyon ve plağa tespitine olanak sağlamaktadır. Deltopektoral girişime göre hastanın iyileşme sürecinde Constant skorları anlamlı olarak farklıdır. Aksiller siniri eksplore ederek yapılan lateral deltoid split girişim, deltoid kas fonksiyonlarını ve aksiller siniri tehlikeye atmadan geniş ve çok yönlü kırık kontrolü sağlayan faydalı bir cerrahi girişim tekniğidir. GİRİŞProksimal humerus kırıkları sık görülen ve üst ekstremitede ciddi fonksiyonel kısıtlanmaya neden olan kırıklardır. Proksimal humerus kırıklarında en yaygın kullanılan cerrahi yaklaşım deltopektoral girişimdir. Plak ile internal fiksasyon sırasında humerusun lateral yüzeyinin net olarak görülmesi gerekebilmektedir. Özellikle atletik hastalarda deltoid ve pektoralis majör kaslarının distal yapışma yerleri deltopektoral yaklaşım ile yapılacak cerrahi girişim esnasında proksimal humerus lateraline ulaşımı kısıtlamaktadır. Proksimal humerus kırıkları-nın tedavisinde kullanılan diğer cerrahi yaklaşım lateral deltoid split girişimdir. [1,2] Deltoid split yaklaşımla humerus başı, tüberculum majus, proksimal humeral şaftın lateral kısmı ve döndürücü manşet direkt görüntülenebilir. Bu yaklaşımın en önemli tehlikesi, aksiller sinirin seyri ve bu sinire ait varyasyonlardan kaynaklanmaktadır.[3] Bu çalışmanın amacı deltopektoral ve deltoid split yaklaşım kullanılarak cerrahi tedavisi yapılan proksimal humerus kırıklı olguların sonuçlarını incelemek ve iki farklı cerrahi yaklaşımın avantaj ve dezavantajlarını karşılaştırmaktır.

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The Extended Anterolateral Acromial Approach Allows Minimally Invasive Access to the Proximal Humerus

Cited by 144 publications

References 24 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

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

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

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