Background
open reduction and internal fixation of proximal humerus fracture through the classic
deltopectoral approach has some disadvantages and complications. The purpose of the
study was to assess the results of locked proximal humeral plate through a mini invasive
anterolateral deltoid split incision in the management of proximal humerus fracture.
Patients and methods
Between January 2013 and November 2015, 23 patients (10 male and 13 female) with
displaced proximal humerus fracture were treated with plating using proximal humerus
locked plate through mini-invasive anterolateral deltoid splitting approach at Benha University
hospital. The inclusion criteria included patients with displaced 2 part (15 patient),
3 part (6 patients) and 4 part (2 patient) proximal humerus fracture according to Neer
classification. The average age of the patients was 45 years (+_9.9) ranging from 32 years
to 65 years. Functional outcomes were assessed according to the Constant- Murley scoring
system, DASH Score, and Visual Analogue Scale Score for pain
Results
Mean follow- up period was 20.6 (±7) months ranging from 12 to 36 months. All cases
united with a mean union time of 11.2 (±2.6) weeks. The mean postoperative shoulder
flexion was 141.5° (±23.9°), extension was 49° (±6.9°), internal rotation 50.8° (±9.6°),
external rotation was 67.3° (±15.3°) and abduction was 148.9° (±24.6°).. The mean postoperative
Constant Score was 79.4 (±11.7) ranging from 52 to 96. The mean DASH Score
was 27.6 (±9.7) ranging from 5 to 52 and the mean pain Visual Analogue Scale Score was
0.95 (±0.93) ranging from zero to 3. Complication rate was low 8.6%. One case developed
impingement and plate was removed after 12 months. Another case united in mild
varus but without complaint. No patient developed avascular necrosis or screw cut-out
with no recorded cases of axillary nerve injury or partial deltoid weakness.
Conclusion
the use of minimally invasive deltoid split approach is easy and safe method for fixation
of proximal humerus fracture using proximal humeral locked plate with favorable outcome
and low complication rates. |
