Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3-and 4-part proximal humerus fractures

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

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Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2012.2592 ◽

2012 ◽

Vol 46 (3) ◽

pp. 154-160 ◽

Cited By ~ 13

Author(s):

Neslihan Aksu

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Humerus Fractures

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A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation

10.21203/rs.3.rs-46139/v1 ◽

2020 ◽

Author(s):

Fu Wang ◽

Yan Wang ◽

Jinye Dong ◽

Yu He ◽

Lianxin Li ◽

...

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Shoulder Joint ◽

Locking Plate ◽

Proximal Humerus ◽

Plate Fixation ◽

Anterolateral Approach ◽

Proximal Humerus Fractures ◽

Locking Plate Fixation ◽

Humerus Fractures

Abstract Background and hypothesis: The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.Materials and Methods: An anatomical study was performed and an anatomical medial locking proximal humerus plate was designed based on the measurement results. Between November 2014 and April 2017, eight cases of proximal humerus fractures with unstable medial columns underwent medial fixation. All surgeries were performed by a single surgeon. Patients were followed clinically and radiographically at 1, 3, 6 and 12 months postoperatively.Results: There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10 degrees in any direction), screw cutout, nonunion, or deep infection occurred.Conclusions: The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.Level of evidence: Retrospective Study

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Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-15-206 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 27

Author(s):

Tao Lin ◽

Baojun Xiao ◽

Xiucai Ma ◽

Dehao Fu ◽

Shuhua Yang

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Locking Compression Plate ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures

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Minimally invasive percutaneous plate osteosynthesis for the treatment of proximal humerus fractures in osteoporotic patients with Philos plate

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v12i2.14941 ◽

2013 ◽

Vol 12 (2) ◽

pp. 140-145

Author(s):

Ram Ji Lal Sahu

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Medical Science ◽

Functional Results ◽

Autogenous Bone ◽

Proximal Humerus Fractures ◽

Philos Plate ◽

Humerus Fractures ◽

A Prospective Study

Introduction: To investigate the effect of minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate. Methods: A prospective study was conducted at Department of Orthopedics, M.M.Medical College, Mullana Ambala, from July 2005 to November 2010. A Total of 108 cases of proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis with philos plate. According to Neer classification, 89 cases had two part fractures, 19 had tree part fractures. Results: All the 108 cases were followed up ranging from 12 to 18 months with an average of 14 months. Radio graphically, union was observed in 92 patients at the end of 10 weeks. In 10 patients, times to union were 16 weeks. Six patients underwent autogenous bone grafting because of nonunion after 16 weeks. The mean Constant-Murley score was 86 (range 74-92). The functional results of the shoulder, according to Muley scores, were classified as excellent in 85.15% cases, good in 9.25% cases and fair in 5.55 cases. Conclusion: Minimally invasive percutaneous plate osteosynthesis for treatment of proximal humerus fractures in osteoporotic patients with philos plate shows good results and less complication. Bangladesh Journal of Medical Science Vol. 12 No. 02 April13 Page 140-145 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14941

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Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures: A Retrospective Study Describing Principles and Advantages of the Technique

Advances in Orthopedics ◽

10.1155/2018/5904028 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Riccardo Luigi Alberio ◽

Matteo Del Re ◽

Federico Alberto Grassi

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humeral Fractures ◽

Radiographic Evaluation ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Greater Tuberosity ◽

Humerus Fractures ◽

The Mean

Background. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Materials and Methods. From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48–80) were surgically treated with the MIPO technique for proximal humeral fractures. According to Neer classification, there were 12 two-part, 24 three-part, and 2 four-part fractures and 1 two-part fracture-dislocation; the AO/OTA system was also used to categorize the fractures. The Constant-Murley (CMS) and the Oxford Shoulder (OSS) Scores were used to evaluate shoulder function. Results. Thirty-four patients were available for clinical and radiographic evaluation at a mean follow-up of 31.8 months (range: 12–54 months). All fractures healed and no postoperative complications occurred. Full recovery of pretrauma activities was reported by 27 patients, while 7 patients presented mild functional limitations. The mean absolute CMS was 75.2 (range: 55–95), the mean normalized CMS was 90.5 (range: 69–107), and the mean OSS was 43.7 (range: 31–48). The only statistically significant correlation was found between the female gender and lower absolute CMS and OSS. Radiographic evaluation revealed varus malunion in 4 cases and valgus malunion in 1 case, while incomplete greater tuberosity reduction was detected in 4 cases. All malunions were related to inadequate reduction at time of surgery and not to secondary displacement. Conclusions. MIPO for proximal humeral fractures is an effective and safe surgical procedure. The limited tissue dissection allows minimizing the incidence of nonunion, avascular necrosis, and infection. The technique is not easy, requires experience to achieve mastery, and should be reserved for selected fracture patterns. In our experience, the main advantage of this approach consists in the direct access to the greater tuberosity, thus facilitating its anatomic reduction and fixation.

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