Clinical evaluation of an antero-medial approach for plate fixation of the proximal humeral shaft
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Burak Akan Mehmet Armangil Kerem Basarir Halil Acar Sinan Sirri Bilgin Mehmet Demirtas
- چاپ و سال / کشور: 2011
Description
Objective Surgical approach of fractures of the proximal humeral shaft should protect the muscular insertions and the vascularisation of fragments, improving bone union and functional recovery. The aim of this study is to review cases operated with an original anteromedial approach, in cases of specific fractures of the proximal humeral shaft. Materials and methods Prior to clinical application, a cadaveric study was accomplished. Based on the results, six clinical cases had surgery using an approach medial to the biceps and brachialis. The osteosynthesis was performed with locked plates and 4.5 screws. The approach was indicated in fractures presenting with a large lateral wedge including the deltoid muscle insertion. Stable osteosynthesis achieved with this approach allowed early postoperative mobilization of the arm in all cases. Results The case-series consisted of three women and three men with a mean age of 52.1 years (range 38–68). The minimal follow-up was 1 year. Bone union was observed at an average time of 11.2 weeks. There were no intra- or postoperative complications. Discussion Open reduction and internal fixation with compression plating is a standardized and successful procedure in the treatment of humeral fractures. Internal fixation with lateral plating is difficult in the proximal third of the humeral shaft, where the positioning of the implant may hurt the long biceps tendon and the deltoid insertion. This approach was successful and safe in the presented cases. Conclusion The antero-medial approach with metaphyseal locking plate protects the muscular insertions and the vascularisation of the wedge fragment, leading to good results in all the cases in this series.
Eur J Orthop Surg Traumatol DOI 10.1007/s00590-011-0843-5 Received: 5 May 2011 / Accepted: 3 July 2011
