Evaluation of axillary nerve integrity and shoulder functions in patients who underwent lateral deltoid splitting approach

Year 2020, , 645 - 648, 01.08.2020

Ömer Kays Unal , Miruna Florentina Ateş , Mirza Zafer Dağtaş , Ender Ugutmen

https://doi.org/10.28982/josam.777069

Abstract

Aim: The most common complication of the Lateral deltoid splitting approach (LDSA), which is used in the shoulder area, especially for posterior extension fractures and other soft tissue pathologies, is axillary nerve injury. Determining the frequency of nerve injuries that may occur after LDSA is decisive for the applicability of this approach. Therefore, in our study, we aimed to evaluate the axillary nerve integrity and shoulder functions in patients who underwent LDSA.
Methods: In this prospective cohort study, 55 patients who were operated with LDSA for proximal humerus fractures between February 2015 and July 2018 were evaluated. Among these patients, 35 were selected and included in the study. Six months later Electrophysiological tests (Electroneuromyelography – ENMG) and Constant Shoulder Score (CSS) were used for evaluation of each operated and non-operated shoulder. CSS difference between the operated and non-operated sides was graded as mild (11-20 point), moderate (21-30) and severe (>30).
Results: Mean age of the group was 66 (9) years. Twenty-five patients were female and 10 were male. Mean follow-up time was 4 (1) years. Mean latencies of axillary nerve were 4.6 (1.8) msn, 3.7 (0.54) msn and mean amplitudes of axillary nerve were 6.6 (2.21) mV, 8.4 (2.80) mV in the operated and non-operated shoulders, respectively. There was no statically significant difference between the operated and non-operated sides according to latency and amplitude (latency P=0.25, amplitude P=0.16). Mean CSS of the patients were 28.7. CSS of 12 patients were severe (mean: 39.08), 18 patients, moderate (mean 25.4) and 5 patients, mild (mean 16). There was no statically significant correlation between CSS and axillary nerve latency / amplitude (P= 0.62, r=0.267 / P=0.98, r=-0.339). Fracture type and CSS showed a statically significant correlation (P=0.032, r= 0.829).
Conclusion: This study revealed that LDSA provides wide and versatile fracture control without compromising the deltoid muscle functions and axillary nerve, especially in fractures extending to the posterior part of the proximal humerus.

Keywords

Proximal humeral fractures, Deltoid-splitting approach, Nerve crush, Electromyography

Lateral deltoid splitting yaklaşım uygulanan hastalarda aksiller sinir bütünlüğünün ve omuz fonksiyonlarının değerlendirilmesi

Abstract

Amaç: Omuz bölgesinin özellikle posterior uzanımlı kırıklarında ve diğer yumuşak doku patolojilerinde uygulanmakta olan Lateral deltoid splitting yaklaşım (LDSY)’ın en bilinen komplikasyonu aksiller sinir yaralanmasıdır. LDSY sonrası oluşabilecek sinir yaralanmalarının sıklığını belirlemek bu yaklaşımın uygulanabilirliği açısından belirleyicidir. Bu nedenle çalışmamızda, LDSY uygulanan vakalarda aksiller sinir bütünlüğünü ve omuz fonksiyonlarını değerlendirmek amaçlanmıştır.
Yöntemler: Prospektif kohort tipteki bu çalışmada Şubat 2015-Temmuz 2018 tarihleri arasında proksimal humerus kırığı nedeniyle LDSA uygulanarak opere edilen 55 hastanın verileri incelendi. Bu hastalar arasından seçilen 35 hasta çalışmaya alındı. Altı ay sonra tüm hastaların opere edilen ve edilmeyen omuzları elektrofizyolojik testler (Elektronöromiyelografi - ENMG) ve Constant Omuz Skoru (CSS) ile karşılaştırmalı olarak değerlendirildi. Opere edilen ve edilmeyen omuzların CSS farkları hafif (11-20), orta (21-30), şiddetli (>30) olarak derecelendirildi.
Bulgular: Hastaların yaş ortalaması 66(9) idi. Hastaların 25’i kadın, 10’u erkek hasta idi. Ortalama takip süresi 4(1) yıl idi. Opere olan ve olmayan omuz bölgelerinde yapılan ENMG incelemelerinde aksiller sinirin ortalama latansı sırasıyla 4,6(1,8) msn, 3,7(0,54) msn ve ortalama amplitude’u sırasıyla 6,6(2,21) mV, 8,4(2,80) mV idi. Latans ve amplitude değerlerine göre ameliyat edilen ve ameliyat edilmeyen taraflar arasında istatistiksel olarak anlamlı bir fark saptanmadı (latans P=0,25, amplitude P=0,16). Hastaların ortalama CSS skoru 28,7 idi. CSS’in 12 hastada şiddetli (ortalama: 39,08), 18 hastada orta (ortalama 25,4) ve 5 hastada hafif (ortalama 16) olduğu saptandı. CSS ve aksiller sinir latans / amplitude değerleri arasında istatistiksel olarak anlamlı bir korelasyon saptanmadı (P= 0,62, r=0,267 / P=0,98, r=-0,339). Kırık tipi ve CSS arasında ise istatistiksel olarak anlamlı korelasyon olduğu görüldü (P=0,032, r=0,829).
Sonuç: Bu çalışma sonucunda, LDSA’nın aksiller sinir’e ve omuz fonksiyonlarına zarar vermeden özellikle proksimal humerusun arka kısmına uzanan kırıklarda geniş ve çok yönlü kırık kontrolü sağladığı saptanmıştır.

Keywords

Proksimal humerus kırıkları, Deltoid-splitting yaklaşım, Sinir yaralanması, Elektromiyografi

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