Functional results of deltoid split minimally invasive osteosynthesis for neer type 3 proximal humerus fractures

Yıl 2023, , 134 - 139, 12.01.2023

Taner Bekmezci , Serdar Kamil Çepni , Suat Batar , Ali Şişman

https://doi.org/10.32322/jhsm.1214157

Öz

Aim: We aimed to evaluate the short-term functional and radiological outcomes of the minimally invasive fixation of three-part proximal humerus fractures without using calcar screws.
Material and Method: Twenty patients were treated with the minimally invasive approach using locking plate-screws. The relationship between the cephalo-diaphyseal angles and the functional outcomes were evaluated.
Results: The mean follow-up time were 22.7 months. The mean Constant-Murley score of the patients was 83.7. The modified Constant-Murley score was excellent in 16 and good in four patients. A statistically significant difference was detected between cephalo-diaphyseal angles.
Conclusion: Osteosynthesis with minimally invasive plate-screw and deltoid splitting application is encouraging with its satisfactory results in three-part fractures of the humerus; however, the total complication rate of 35% should not be ignored. In addition, in order to prevent a significant varus collapse and angular loss, the fracture subgroups should be studied in detail and additional measures should be taken based on the fracture type.

Anahtar Kelimeler

Calcar screw, deltoid split, MIPO, proximal humerus fracture

Kaynakça

• Hinds RM, Garner MR, Tran WH, Lazaro LE, Dines JS, Lorich DG. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation. J Shoulder Elbow Surg 2015; 24: 889-96.
• Gardner MJ, Voos JE, Wanich T, Helfet DL, Lorich DG. Vascular implications of minimally invasive plating of proximal humerus fractures. J Orthop Trauma 2006; 20: 602-7.
• Edwards SL, Wilson NA, Zhang LQ, Flores S, Merk BR. Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques. J Bone Joint Surg Am 2006; 88: 2258-64.
• Seide K, Triebe J, Faschingbauer M, et al. Locked vs. unlocked plate osteosynthesis of the proximal humerus - a biomechanical study. Clin Biomechanics (Bristol, Avon) 2007; 22: 176-82.
• Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury 2011; 42: 408-13.
• Sohn HS, Shin SJ. Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type. J Shoulder Elbow Surg 2014; 23: 1334-40.
• Kim SH, Lee YH, Chung SW, et al. Outcomes for four-part proximal humerus fractures treated with a locking compression plate and an autologous iliac bone impaction graft. Injury 2012; 43: 1724-31.
• Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res 2011; 6: 50.
• Yang P, Zhang Y, Liu J, Xiao J, Ma LM, Zhu CR. Biomechanical effect of medial cortical support and medial screw support on locking plate fixation in proximal humeral fractures with a medial gap: a finite element analysis. Acta Orthopaedica et Traumatologica Turcica 2015; 49: 203-9.
• Lin T, Xiao B, Ma X, Fu D, Yang S. Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures. BMC Musculoskeletal Disorders 2014; 15: 206.
• Liu K, Liu PC, Liu R, Wu X. Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures. Medical science monitor : international medical journal of experimental and clinical research 2015; 21: 496-504.
• Altman GT, Gallo RA, Molinero KG, Muffly MT, Mascarenhas L. Minimally invasive plate osteosynthesis for proximal humerus fractures: functional results of treatment. Am J Orthop (Belle Mead, NJ) 2011; 40: 40-7.
• Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Related Res 1987: 160-4.
• Barco R, Barrientos I, Encinas C, Antuña SA. Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus. Injury 2012; 43: 7-11.
• Oh HK, Cho DY, Choo SK, Park JW, Park KC, Lee JI. Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis. Archives of Orthopaedic and Trauma Surgery 2015; 135: 235-42.
• Boileau P, Walch G. The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. J Bone Joint Surg Br Vol 1997; 79: 857-65.
• Vijayvargiya M, Pathak A, Gaur S. Outcome analysis of locking plate fixation in proximal humerus fracture. J Clin Diagnostic Res JCDR 2016; 10: 1-5.
• Atalar AC, Demirhan M, Uysal M, Seyahi A. [Treatment of Neer type 4 impacted valgus fractures of the proximal humerus with open reduction, elevation, and grafting]. Acta Orthopaedica et Traumatologica Turcica 2007; 41: 113-9.
• Atalar AC, Eren I, Uludağ S, Demirhan M. Results of surgical management of valgus-impacted proximal humerus fractures with structural allografts. Acta Orthopaedica et Traumatologica Turcica 2014; 48: 546-52.
• Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. Results of operative treatment. J Bone Joint Surg American 2003; 85: 1647-55.
• Robinson CM, Page RS. Severely impacted valgus proximal humeral fractures. J Bone Joint Surg American 2004; 86: 143-55.
• Bae JH, Oh JK, Chon CS, Oh CW, Hwang JH, Yoon YC. The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Joint Surg British 2011; 93: 937-41.
• Osterhoff G, Baumgartner D, Favre P, et al. Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg 2011; 20: 740-6.
• Parada SA, Makani A, Stadecker MJ, Warner JJ. Technique of open reduction and internal fixation of comminuted proximal humerus fractures with allograft femoral head metaphyseal reconstruction. Am J Orthop (Belle Mead, NJ) 2015; 44: 471-5.
• Rotari V, Moussallem CD, David E, Mertl P, Havet E. Position of the anterior branch of the axillary nerve in relation to the humeral bone length. Am J Orthop (Belle Mead, NJ) 2012; 41: 452-5.
• Röderer G, Sperfeld AD, Hansen P, Krischak G, Gebhard F, Kassubek J. Electrophysiological assessment of the deltoid muscle after minimally invasive treatment of proximal humerus fractures - a clinical observation.Open Orthop J 2011; 5: 223-8.
• Park J, Jeong SY. Complications and outcomes of minimally invasive percutaneous plating for proximal humeral fractures. Clin Orthop Surg 2014; 6: 146-52.
• Koljonen PA, Fang C, Lau TW, Leung F, Cheung NW. Minimally invasive plate osteosynthesis for proximal humeral fractures. J Orthop Surg (Hong Kong) 2015; 23: 160-3.