Complex proximal humerus fractures treated with locked plating utilizing an extended deltoid split approach with a shoulder strap incision

摘要

OBJECTIVES: The goal of the study is to analyze the outcome and complications after locked plating of proximal humerus fractures with the extended deltoid split approach though a shoulder strap incision. DESIGN: Prospective. SETTING: Tertiary care referral center. PATIENTS: Fifty-two adult patients with a displaced 3 or 4 part proximal humerus fracture or fracture dislocation. INTERVENTIONS: Open reduction and locked plate osteosynthesis through an extended deltoid split approach using a strap incision. OUTCOME MEASUREMENTS: Electrophysiological assessment of axillary nerve function at 6 weeks and at 3, 6, and 12 months postoperatively in those patients in whom an abnormality was detected postoperatively. Functional outcome measurement using normalized Constant scores at 6 and 12 months. Other measures include radiological assessment and complications. RESULTS: Traction injury to the anterior part of the axillary nerve was electrically evident but not clinically apparent in 4 patients. The normalized Constant score continued to show significant improvement 1 year post surgery, 67.3 ± 11.3 at 6 months and 80.2 ± 7.7 at 1 year (P = 0.001)). Union was obtained in all patients. Varus/valgus/tuberosity malreductions were seen in 8 patients. Loss of reduction was seen in 2 patients. Two patients had radiological evidence of avascular necrosis at 1-year follow-up. CONCLUSIONS: Locked plating of proximal humerus fractures through an extended deltoid split approach using a shoulder strap incision provides satisfactory outcomes. Axillary nerve injury is the only limitation of the approach and can be minimized with careful identification and protection of the nerve throughout the procedure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.