Clin Should Elbow.  2018 Dec;21(4):220-226. 10.5397/cise.2018.21.4.220.

Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoidsplitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures

Affiliations
  • 1Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea. thugdoc@naver.com
  • 2Department of Shoulder Clinic, Mirae Hospital, Busan, Korea.

Abstract

BACKGROUND
This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures.
METHODS
From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >5° loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated.
RESULTS
In all cases, complete union was achieved. The ASES and VAS scores were improved to 85.4 ± 2.1 and 3.2 ± 1.3, respectively. Twelve patients (75.0%) had greater than a 5° change in NSA; the average NSA change was 3.8°. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a < 100° active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit.
CONCLUSIONS
Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.

Keyword

Shoulder fractures; Allografts; Fibula; Minimally invasive surgical procedures; Range of motion

MeSH Terms

Aged
Allografts*
Arthroplasty
Classification
Elbow
Fibula
Follow-Up Studies
Humans
Humeral Head
Minimally Invasive Surgical Procedures
Neck
Necrosis
Osteoporosis
Range of Motion, Articular
Shoulder
Shoulder Fractures*
Surgeons
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