2017, Number 1
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Acta Ortop Mex 2017; 31 (1)
Osteosynthesis with locking plate and minimally invasive technique for proximal humeral fractures
Arroyo-Sánchez C, Abril-Gaona C, Rincón-Cardozo D
Language: Spanish
References: 23
Page: 18-23
PDF size: 506.14 Kb.
ABSTRACT
Objective: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients’ outcomes.
Material and methods: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale.
Results: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109
º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions.
Conclusions: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.
REFERENCES
Barco R, Barrientos I, Encinas C, Antuña SA. Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus. Injury. 2012; 43(Suppl 2): S7-11.
Papadopoulos P, Karataglis D, Stavridis SI, Petsatodis G, Christodoulou A. Mid-term results of internal fixation of proximal humeral fractures with the Philos plate. Injury. 2009; 40(12): 1292-6.
Acklin YP, Jenni R, Walliser M, Sommer C. Minimal Invasive PHILOS(®)-Plate osteosynthesis in proximal humeral fractures. Eur J Trauma Emerg Surg. 2009; 35(1): 35-9.
Resch H. Proximal humeral fractures: current controversies. J Shoulder Elbow Surg. 2011; 20: 827-32.
Lee CW, Shin SJ. Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation. J Shoulder Elbow Surg. 2009; 18(1): 83-8.
Ricchetti ET, Warrender WJ, Abboud JA. Use of locking plates in the treatment of proximal humerus fractures. J Shoulder Elbow Surg. 2010; 19: 66-75.
Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury. 2013; 44(4): 456-60.
Gavaskar AS, Muthukumar S, Chowdary N. Biological osteosynthesis of complex proximal humerus fractures:surgical technique and results from a prospective single center trial. Arch Orthop Trauma Surg. 2010; 130(5): 667-72.
Röderer G, Erhardt J, Graf M, Kinzl L, Gebhard F. Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma. 2010; 24: 400-6.
Plecko M. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Operat Orthop Traumatol. 2005; 17: 25-50.
Smith J, Berry G, Laflamme Y, Blain-Pare E, Reindl R, Harvey E. Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury. 2007; 38: 206-11.
Montiel-Giménez A, Granell-Escobar F, Gallardo-Villares S, Franco-Gómez R, Escolá-Benet A. Results of percutaneous treatment of proximal humeral fractures in patients of working age. Rev Esp Cir Ortop Traumatol. 2011; 55(6): 446-53.
Gardner MJ, Voos JE, Wanich T, Helfet DL, Lorich DG. Vascular implications of minimally invasive plating of proximal humerus fractures. J Orthop Trauma. 2006; 20: 602-7.
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004; 13: 427-33.
Ricci WM. Locked plate fixation for fractures of the proximal humerus. Tech Orthop. 2007; 22: 192-196.
Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal humerus. J Orthop Trauma. 2008; 22(2): 132-7.
Röderer G, Sperfeld AD, Hansen P, Krischak G, Gebhard F, Kassubek J. Electrophysiological assessment of the deltoid muscle after minimally invasive treatment of proximal humerus fractures. A clinical observation. Open Orthop J. 2011; 5: 223-8.
Aksu N, Karaca S, Kara AN, Işiklar ZU. Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures. Acta Orthop Traumatol Turc. 2012; 46(3): 154-60.
Gardner MJ, Griffith MH, Dines JS, Lorich DG. A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis. 2004; 62(1-2): 18-23.
Rancan M, Dietrich M, Lamdark T, Can U, Platz A. Minimal invasive long PHILOS1-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus. Injury. 2010; 41: 1277-83.
Brunner A, Thormann S, Babst R. Minimally invasive percutaneous plating of proximal humeral shaft fractures with the proximal humerus internal locking system (PHILOS). J Shoulder Elbow Surg. 2012; 21: 1056-63.
Kobayashi M, Watanabe Y, Matsushita T. Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures. J Orthop Trauma. 2010; 24: 212-6.
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987; 214: 160-4.