1
|
OKUTAN AE. Plate osteosynthesis for proximal humerus fractures through a deltoid-split approach under traction in lateral decubitus position: preliminary results. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1166982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aim: We aimed to present deltoid split approach under traction in lateral decubitus position that we perform for the treatment of proximal humerus fractures (PHFs) and to present the preliminary surgical and clinical outcomes of our patients.
Material and Method: Twelve patients who underwent plate osteosynthesis through a deltoid split approach under traction in lateral decubitus position between May 2019 and January 2021 were evaluated. Patient demographics, Neer classification, and time from injury to surgery were collected in all patients preoperatively. Radiation exposure time and operating time was recorded intraoperatively. Radiological outcomes were assessed, including time to union, and neck-shaft angle. Functional outcomes were evaluated using the Constant score at the minimum 12-month follow-up.
Results: Twelve patients (5 male, 7 female) were evaluated with a mean age 58.6±10.7 years (range, 32 to 72 years) at the time of surgery. The mean follow-up period was 117.4±3.8 months). The mean operation time was 60.7±15.2 min (range, 44 to 92 min). The mean radiation exposure time was 6.1±3.0 s (range, 3.3 to 14.2 s). Fracture union was observed in all patients at mean 14.6±2.5 weeks (range, 8 to 20 weeks). The mean neck-shaft angle after the union was 134.5±3.4 degrees (range, 124 to 143 degrees). The mean Constant score was at the final follow-up was 76.4±8.7 (range, 63 to 90).
Conclusion: Patient positioning in the lateral decubitus position under traction can be considered as a safe, reliable, and reproducible method in selected patients with PHFs.
Collapse
|
2
|
Liu B, Wang X, Wang C, Jiao Z, Chen W. Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study. Medicine (Baltimore) 2022; 101:e29075. [PMID: 35687768 PMCID: PMC9276129 DOI: 10.1097/md.0000000000029075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach. METHODS This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients' functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score. RESULTS A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12-21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049). CONCLUSION The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.
Collapse
Affiliation(s)
- Bin Liu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
- The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, No. 306 Jiankang Road, Linqing, P.R. China
| | - Xinguang Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
| | - Chao Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
| | - Zhenqing Jiao
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
| | - Wei Chen
- Hebei Institute of Orthopedic Research, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, P.R. China
| |
Collapse
|
3
|
Pan X, Yao Y, Yan H, Wang J, Dai L, Qu X, Fang Z, Feng F, Zhou Y. Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes. Eur J Med Res 2021; 26:73. [PMID: 34247652 PMCID: PMC8274043 DOI: 10.1186/s40001-021-00545-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. METHODS A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. RESULTS A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). CONCLUSION A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.
Collapse
Affiliation(s)
- Xiaohui Pan
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yong Yao
- Department of Orthopedics, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, 445000, Hubei, People's Republic of China
| | - Hongyong Yan
- Department of Orthopedics, Jiangxia District Hospital of Traditional Chinese Medicine, Jiangxia, 430200, Hubei, People's Republic of China
| | - Jun Wang
- Department of Orthopedics, Huangshi Second People's Hospital, Huangshi, 435000, Hubei, People's Republic of China
| | - Lei Dai
- Department of Orthopedics, Huangmei County Hospital of Traditional Chinese Medicine, Huangmei, 438500, Hubei, People's Republic of China
| | - Xincong Qu
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Zuyi Fang
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Feng Feng
- Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China
| | - Yan Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, #238 Jiefang Road, Wuhan, 430060, Hubei, People's Republic of China.
| |
Collapse
|
4
|
Ekdahl M, Dominguez C, Pinedo M, López S, Gutiérrez V. New precontoured long locking plate for proximal metadiaphyseal fractures of the humerus: a cadaveric study for its use with the minimally invasive technique. JSES Int 2021; 5:540-545. [PMID: 34136867 PMCID: PMC8178608 DOI: 10.1016/j.jseint.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this study was to identify nerves at risk when using a minimally invasive plate osteosynthesis precontoured long proximal humerus locking plate and to evaluate the risk of injury to deltoid insertion and brachialis muscle. Methods Ten cadaveric upper limb specimens were used. A transdeltoid anterolateral approach was performed proximally and a second anterior approach was performed distally. A 14-hole “low” long precountored ALPS locking plate (Biomet Trauma; Zimmer Biomet, Warsaw, IN, USA) was used. Subsequently, anatomic dissection to measure the anatomic relationship of the plate with the deltoid insertion, with the brachialis muscle, and with the axillary, radial, and musculocutaneous nerves was performed. Results The mean humeral length was 302 mm (standard deviation 52.3, 99% confidence interval: 259.3-344.6). In 6 specimens, the axillary nerve was located at the level of the third row of holes of the plate; in 3 specimens, at the level of the fourth row; and in one specimen, at the level of the second row. The distance between the plate and the musculocutaneous nerve was on average 10.2 mm (standard deviation 4, 99% confidence interval: 6.9-13.5) and between the plate and the radial nerve was on average 7.9 mm (standard deviation 4.7, 99% confidence interval: 4-11.8). The plate pierced the anterior distal fibers of the deltoid in all specimens. In 8 specimens, no brachialis muscle fibers were located under the plate. Conclusions The use of the long precontoured 14-hole ALPS locking plate with the minimally invasive plate osteosynthesis technique, previously identifying the axillary and musculocutaneous nerves, is feasible; however, the distances between the plate and the nerves remain low, so caution should be maintained. Despite the curved design of the plate, the deltoid insertion is partially compromised in all cases.
Collapse
Affiliation(s)
- Max Ekdahl
- Corresponding author: Max Ekdahl, MD, Orthopaedic Surgery Department, Clinica Las Condes, Santiago, Chile.
| | | | | | | | | |
Collapse
|
5
|
Wang JQ, Lin CC, Zhao YM, Jiang BJ, Huang XJ. Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study. BMC Musculoskelet Disord 2020; 21:406. [PMID: 32593311 PMCID: PMC7321543 DOI: 10.1186/s12891-020-03417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. However, the optimal method for open reduction and internal fixation (ORIF) remains controversial. METHODS We performed a retrospective analysis of patients with PHF who underwent locking plate internal fixation at our institution from January 2016 to December 2018. Patients were divided into two groups based on the surgical approach used: an expanded deltoid-split approach group (ORIF group) and minimally invasive deltoid-split approach group (minimally invasive percutaneous plate osteosynthesis, [MIPPO] group). The groups were compared in terms of demographic and perioperative characteristics, and clinical outcomes. RESULTS A total of 115 cases of PHF were included in our study, of which 64 cases were treated using the minimally invasive deltoid-split approach and 51 using the extended deltoid-split approach. Fluoroscopy was performed significantly less frequently in the ORIF group and the surgical duration was shorter. However, the postoperative visual analogue scale (VAS) pain score and duration of postoperative hospital stay were significantly higher compared to the MIPPO group. Moreover, secondary loss was significantly less extensive in the ORIF group compared to the MIPPO group, while there was no significant group difference in fracture healing time, Constant shoulder score, or complications at the last follow-up visit. CONCLUSIONS The clinical outcomes associated with both the minimally invasive and extended deltoid-split approaches were satisfactory. The data presented here suggest that the extended deltoid-split approach was superior to the minimally invasive deltoid-split approach in terms of operational time, fluoroscopy, and secondary loss of reduction, while the minimally invasive approach was superior in terms of postoperative pain and hospital stay. Accordingly, neither procedure can be considered definitively superior; the optimal surgical procedure for PHF can only be determined after full consideration of the situation and requirements of the individual patient.
Collapse
Affiliation(s)
- Ji-Qi Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, 325000, Zhejiang, China
| | - Chui-Cong Lin
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village Ouhai District, Wenzhou, 325000, Zhejiang, China
| | - You-Ming Zhao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, 325000, Zhejiang, China
| | - Bing-Jie Jiang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, 325000, Zhejiang, China
| | - Xiao-Jing Huang
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village Ouhai District, Wenzhou, 325000, Zhejiang, China.
| |
Collapse
|
6
|
Branca Vergano L, Landi S, Monesi M. Locked posterior fracture-dislocation of the shoulder. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:139-146. [PMID: 31821298 PMCID: PMC7233701 DOI: 10.23750/abm.v90i12-s.8972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK To describe a valid option for the treatment of locked posterior fracture-dislocation of the shoulder (LPFDS) and to compare it to the literature about this topic. METHODS We present a small case series (3 patients), with a medium follow up at 4 years and 5 months. We accurately describe our surgical strategies, underlining the choice of approach, reduction and fixation. RESULTS The three patients showed excellent functional and radiological results at the follow up examinations, with a full range of shoulder movements and complete regain of pre-trauma activities. A lateral approach (standard or minimally invasive), a reduction technique with a Shantz pin in the head and in the humeral shaft, and fixation with a locking plate were used in the three patients. CONCLUSION LPFDS is a challenging lesion, hard to recognize and to treat. Our suggested method of treatment is highly reproducible and has revealed itself to be very effective in achieving good results.
Collapse
|
7
|
Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury 2019; 50:2176-2195. [PMID: 31727401 DOI: 10.1016/j.injury.2019.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
Locking plating is a common surgical treatment of proximal humeral fractures with satisfactory clinical results. Implant-related complications, especially screw-related, have been reported, however, the lack of information regarding their onset, used surgical technique, complexity of the fracture, bone quality etc., prevents from understanding the causes for them. The aim of this systematic review is to identify the potential risk factors for late screw complications by gathering information about the patient characteristics, comorbidities, fracture types, surgical approaches and implant types. A PubMed search was performed using humerus, fractures, bone and locking as keywords in clinical papers written in English. All abstracts and manuscripts on distal or humerus shaft fractures, and those on proximal humerus fractures without any or with only iatrogenic complications were excluded. One hundred studies met the inclusion criteria, resulting in 33% of the reported cases having at least one complication, with 11% of all complications being screw-related. Most of the latter were secondary screw perforations and screw cut-outs, being predominantly linked to poor bone quality, while screw loosening and retraction were found less frequently as a result of locking mechanism failure. Overall, the amount of information for complications was limited and screw perforation was the most frequent screw-related complication, mostly reported in female patients older than 50 years, following four-part or AO/OTA type C fractures and detected four weeks postoperatively. The sparse information in the literature could be an indicator that the late screw complications might have been under-reported and under-described, making the understanding of the screw-related complications even more challenging.
Collapse
Affiliation(s)
- Vasiliki C Panagiotopoulou
- AO Research Institute Davos, Davos, Switzerland; School of Chemical and Processing Engineering, Engineering Building, University of Leeds, UK.
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
| | | | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
| |
Collapse
|
8
|
Noh YM, Kim DR, Kim CH, Lee SY. Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoidsplitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures. Clin Shoulder Elb 2018; 21:220-226. [PMID: 33330180 PMCID: PMC7726400 DOI: 10.5397/cise.2018.21.4.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022] Open
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.
Collapse
Affiliation(s)
- Young-Min Noh
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
| | - Dong Ryul Kim
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
| | - Chul-Hong Kim
- Department of Shoulder Clinic, Mirae Hospital, Busan, Korea
| | - Seung Yup Lee
- Department of Orthopaedic Surgery, Dong-A University Hospital, Busan, Korea
| |
Collapse
|
9
|
Posterior Shoulder Dislocation Associated With the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding Radiologic Signs and Experience With an Extended Deltopectoral Approach. Tech Hand Up Extrem Surg 2018; 22:57-64. [PMID: 29664803 DOI: 10.1097/bth.0000000000000190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this paper, our main objective was to emphasize the competency of extended deltopectoral exposure, enforced with the supraspinatus and subscapularis detachment, to gain access to the entire head. The second important point in this paper was to underline the importance of the knowledge that is necessary for interpreting classic radiologic signs of posterior fracture-dislocation of the shoulder. A 47-year-old woman fell down directly onto her shoulder while she was skiing. She was diagnosed with posterior shoulder dislocation, associated with fracture of the head (head splitting) and humeral neck fracture, with the aid of plain radiographs and computed tomographic results. The patient was treated with open reduction and internal fixation of the fracture, through the extended deltopectoral approach, which was augmented with rotator cuff detachment. At the 1-year follow-up, x-rays showed stable fixation with good evidence of healing. One year after the surgery, the patient had no pain, and she regained most of her functionality in her right shoulder with 140 to 150 degrees of lateral elevation (abduction), 140 to 150 degrees of forward flexion , internal rotation hand at T12 vertebra (slightly restricted). These results showed good functionality, with a painless shoulder at the 1-year follow-up. The "double shadow" and "lightbulb" signs are indicative of posterior shoulder fracture-dislocation, and augmented (with the detachment of supraspinatus and subscapularis tendons) traditional deltopectoral incision is suitable for managing these kinds of difficult fracture dislocations.
Collapse
|