J Korean Fract Soc.  2013 Jan;26(1):8-13. 10.12671/jkfs.2013.26.1.8.

A Separate Approach and Cephalo-Diaphyseal Plate Fixation for the Comminuted Metadiaphyseal Fractures of the Proximal Humerus

• Jung SW

• KMID: 1431710
• DOI: http://doi.org/10.12671/jkfs.2013.26.1.8

Abstract

PURPOSE
To evaluate clinical and radiological outcomes for the comminuted metadiaphyseal fractures of the proximal humerus treated with a separate minimally invasive approach deltopectoral approach for fracture fragment reduction and deltoid splitting approach for cephalo-diaphyseal plate fixation.
MATERIALS AND METHODS
Eighteen patients (6 men and 12 women), who underwent surgery between March 2007 and February 2011, were included. A deltopectoral approach was used to expose and reduce the fracture fragments and an additional deltoid splitting approach was used to expose the humeral head. A locking plate was inserted under the muscle window and a cephalo-diaphyseal fixation was performed. All patients were examined and interviewed using the Visual Analog Scale (VAS) score, Constant score and standardized X-rays to check the time to fracture healing, neck-shaft angle (NSA).
RESULTS
All fractures were united, and mean healing time was 20 weeks. The average VAS score was 3.5 points (range, 0-5) and the average Constant score was 66.5 points (range, 30-90). Final functional outcomes were four cases of excellent, six cases of good, six cases of fair and two cases of poor. The average NSA was 127.5degrees (range, 100-140).
CONCLUSION
A separate approach and cephalo-diaphyseal plate fixation in operative treatment of the metadiaphyseal fractures of the proximal humerus is an effective, reliable treatment option that could reduce the fracture fragments accurately, with less dissection of the soft tissue and lower the complications. A further study including many cases and longer follow-up will be needed to improve the quality of the study.

Keyword

Humerus; Metadiaphyseal; Cephalo-diaphyseal; Plate

MeSH Terms

Follow-Up Studies
Fracture Healing
Humans
Humeral Head
Humerus
Male
Muscles

Figure

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  Fig. 1 (A, B) Preoperative radiographs of 63-year-old woman with comminuted meta-diaphyseal fracture of humerus. Note the long spiral and displacement of the fracture fragments. (C, D) Radiographs at postoperative 18 months shows good alignment and bone union. Neck-shaft angle (NSA) was 130° and the medial cortex was anatomically reduced. (E, F) Preoperative radiographs of 55-year-old woman with comminuted meta-diaphyseal fracture of humerus. (G, H) Radiographs at 12 months show good alignment and bone union. NSA was 130° and the medial cortex was anatomically reduced.

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