Research Article
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Year 2022, Volume: 5 Issue: 6, 1747 - 1751, 25.10.2022
https://doi.org/10.32322/jhsm.1166982

Abstract

References

  • Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev 2016; 4.
  • Omid R, Trasolini NA, Stone MA, Namdari S. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg 2021; 29: e523-e35.
  • Buyukkuscu MO, Kulduk A, Misir A, Cetinkaya E, Camurcu IY, Gursu SS. Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures. Jt Dis Relat Surg 2020; 31: 515-22.
  • Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg 2010; 18: 668-75.
  • Min KS, Sheridan B, Waryasz GR, et al. Predicting reoperation after operative treatment of proximal humerus fractures. Eur J Orthop Surg Traumatol 2021; 31: 1105-12.
  • Dheenadhayalan J, Prasad VD, Devendra A, Rajasekaran S. Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: A study of 127 cases. J Orthop Surg (Hong Kong) 2019; 27: 2309499019848166.
  • Neer CS, 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077-89.
  • Bouliane M, Silveira A, AlEidan A, et al. Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study. JSES Int 2020; 4: 724-9.
  • Rouleau DM, Balg F, Benoit B, et al. Deltopectoral vs. deltoid split approach for proximal humerus fracture fixation with locking plate: a prospective randomized study (HURA). J Shoulder Elbow Surg 2020; 29: 2190-9.
  • Xie L, Zhang Y, Chen C, Zheng W, Chen H, Cai L. Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2019; 105: 307-16.
  • Zhao L, Yang P, Zhu L, Chen AM. Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures. BMC Musculoskelet Disord 2017; 18: 187.
  • Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury 2013; 44: 456-60.
  • Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res 2014; 472: 1576-85.
  • Borer J, Schwarz J, Potthast S, et al. Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg Surg 2020; 46: 825-34.
  • Saran N, Bergeron SG, Benoit B, Reindl R, Harvey EJ, Berry GK. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide. Injury 2010; 41: 1037-40.
  • Kim YG, Park KH, Kim JW, et al. Is minimally invasive plate osteosynthesis superior to open plating for fixation of two-part fracture of the proximal humerus? J Orthop Surg (Hong Kong) 2019; 27: 2309499019836156.
  • Hayda RA, Hsu RY, DePasse JM, Gil JA. Radiation Exposure and Health Risks for Orthopaedic Surgeons. J Am Acad Orthop Surg 2018; 26: 268-77.
  • Wang JQ, Lin CC, Zhao YM, Jiang BJ, Huang XJ. Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study. BMC Musculoskelet Disord 2020; 21: 406.
  • Cheung S, Fitzpatrick M, Lee TQ. Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach. J Shoulder Elbow Surg 2009; 18: 748-55.
  • Oppeboen S, Wikeroy AKB, Fuglesang HFS, Dolatowski FC, Randsborg PH. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res 2018; 13: 197.
  • Knezevic J, Mihalj M, Cukelj F, Ivanisevic A. MIPO of proximal humerus fractures through an anterolateral acromial approach. Is the axillary nerve at risk? Injury 2017; 48: 15-20.
  • Shin YH, Lee YH, Choi HS, Kim MB, Pyo SH, Baek GH. A modified deltoid splitting approach with axillary nerve bundle mobilization for proximal humeral fracture fixation. Injury 2017; 48: 2569-74.
  • Traver JL, Guzman MA, Cannada LK, Kaar SG. Is the axillary nerve at risk during a deltoid-splitting approach for proximal humerus fractures? J Orthop Trauma 2016; 30: 240-4.
  • Harun A, Selin E. What should be the surgical position choice in a patient having proximal humeral fracture with developed hypotension? J Orthopedic Surg Techniques 2021; 4.

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

Year 2022, Volume: 5 Issue: 6, 1747 - 1751, 25.10.2022
https://doi.org/10.32322/jhsm.1166982

Abstract

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.

References

  • Jawa A, Burnikel D. Treatment of proximal humeral fractures: a critical analysis review. JBJS Rev 2016; 4.
  • Omid R, Trasolini NA, Stone MA, Namdari S. Principles of locking plate fixation of proximal humerus fractures. J Am Acad Orthop Surg 2021; 29: e523-e35.
  • Buyukkuscu MO, Kulduk A, Misir A, Cetinkaya E, Camurcu IY, Gursu SS. Effect of surgical approaches on deltoid innervation and clinical outcomes in the treatment of proximal humeral fractures. Jt Dis Relat Surg 2020; 31: 515-22.
  • Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg 2010; 18: 668-75.
  • Min KS, Sheridan B, Waryasz GR, et al. Predicting reoperation after operative treatment of proximal humerus fractures. Eur J Orthop Surg Traumatol 2021; 31: 1105-12.
  • Dheenadhayalan J, Prasad VD, Devendra A, Rajasekaran S. Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: A study of 127 cases. J Orthop Surg (Hong Kong) 2019; 27: 2309499019848166.
  • Neer CS, 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077-89.
  • Bouliane M, Silveira A, AlEidan A, et al. Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study. JSES Int 2020; 4: 724-9.
  • Rouleau DM, Balg F, Benoit B, et al. Deltopectoral vs. deltoid split approach for proximal humerus fracture fixation with locking plate: a prospective randomized study (HURA). J Shoulder Elbow Surg 2020; 29: 2190-9.
  • Xie L, Zhang Y, Chen C, Zheng W, Chen H, Cai L. Deltoid-split approach versus deltopectoral approach for proximal humerus fractures: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2019; 105: 307-16.
  • Zhao L, Yang P, Zhu L, Chen AM. Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures. BMC Musculoskelet Disord 2017; 18: 187.
  • Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury 2013; 44: 456-60.
  • Buecking B, Mohr J, Bockmann B, Zettl R, Ruchholtz S. Deltoid-split or deltopectoral approaches for the treatment of displaced proximal humeral fractures? Clin Orthop Relat Res 2014; 472: 1576-85.
  • Borer J, Schwarz J, Potthast S, et al. Mid-term results of minimally invasive deltoid-split versus standard open deltopectoral approach for PHILOS (proximal humeral internal locking system) osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg Surg 2020; 46: 825-34.
  • Saran N, Bergeron SG, Benoit B, Reindl R, Harvey EJ, Berry GK. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide. Injury 2010; 41: 1037-40.
  • Kim YG, Park KH, Kim JW, et al. Is minimally invasive plate osteosynthesis superior to open plating for fixation of two-part fracture of the proximal humerus? J Orthop Surg (Hong Kong) 2019; 27: 2309499019836156.
  • Hayda RA, Hsu RY, DePasse JM, Gil JA. Radiation Exposure and Health Risks for Orthopaedic Surgeons. J Am Acad Orthop Surg 2018; 26: 268-77.
  • Wang JQ, Lin CC, Zhao YM, Jiang BJ, Huang XJ. Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study. BMC Musculoskelet Disord 2020; 21: 406.
  • Cheung S, Fitzpatrick M, Lee TQ. Effects of shoulder position on axillary nerve positions during the split lateral deltoid approach. J Shoulder Elbow Surg 2009; 18: 748-55.
  • Oppeboen S, Wikeroy AKB, Fuglesang HFS, Dolatowski FC, Randsborg PH. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res 2018; 13: 197.
  • Knezevic J, Mihalj M, Cukelj F, Ivanisevic A. MIPO of proximal humerus fractures through an anterolateral acromial approach. Is the axillary nerve at risk? Injury 2017; 48: 15-20.
  • Shin YH, Lee YH, Choi HS, Kim MB, Pyo SH, Baek GH. A modified deltoid splitting approach with axillary nerve bundle mobilization for proximal humeral fracture fixation. Injury 2017; 48: 2569-74.
  • Traver JL, Guzman MA, Cannada LK, Kaar SG. Is the axillary nerve at risk during a deltoid-splitting approach for proximal humerus fractures? J Orthop Trauma 2016; 30: 240-4.
  • Harun A, Selin E. What should be the surgical position choice in a patient having proximal humeral fracture with developed hypotension? J Orthopedic Surg Techniques 2021; 4.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Ahmet Emin Okutan 0000-0003-1818-9422

Publication Date October 25, 2022
Published in Issue Year 2022 Volume: 5 Issue: 6

Cite

AMA Okutan AE. Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results. J Health Sci Med / JHSM. October 2022;5(6):1747-1751. doi:10.32322/jhsm.1166982

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