A modified deltoid splitting approach with axillary nerve bundle mobilization for proximal humeral fracture fixation

作者：Shin Young Ho; Lee Young Ho^*; Choi Ho Sung; Kim Min Bom; Pyo Sung Hee; Baek Goo Hyun

来源：Injury-International Journal of the Care of the Injured, 2017, 48(11): 2569-2574.

DOI：10.1016/j.injury.2017.09.007

• Proximal humeral fracture
• Minimally invasive plate osteosynthesis
• Deltoid splitting approach
• Deltopectoral approach

Introduction: The deltopectoral and the deltoid splitting approach are commonly used for the treatment of proximal humeral fractures. While the deltopectoral approach requires massive soft tissue devascularization, the deltoid splitting approach needs an additional skipped incision to avoid axillary nerve injury. The purpose of this study was to describe a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures and to assess its radiologic and clinical outcomes.
Patients and methods: Twenty-two consecutive patients with proximal humeral fractures were treated with minimally invasive plate osteosynthesis by using a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization. The patients were divided into two groups: 10 patients of Neer type 2 or 3 fractures vs. 12 patients of Neer type 4 fractures. The mean age of the study population was 63.5 years (range: 30-80 years). Six patients had valgus impacted fractures, and nine had fractures with medial comminution.
Results: Fracture union was achieved in all cases. The mean time to union was 8.6 weeks (range: 6-12 weeks). Major complications, such as avascular necrosis of the humeral head and varus collapse at the fracture site, were not observed. No patients had clinically detectable sensory deficits in the axillary nerve distribution or paralysis of the anterior deltoid muscle. The mean neck-shaft angle at the final follow-up was 136.9 degrees (range, 115 degrees -159 degrees). The mean visual analog score for patient satisfaction was 9.1 (range, 6-10), and the mean Neer scores were 93.5 (range, 84-100). There were no significant differences between the two groups with respect to radiologic and clinical outcomes except Neer scores: 95.8 (range: 86-100) in Neer type 2 or 3 fractures and 91.7 (range: 84-99) in Neer type 4 fractures.
Conclusion: The use of a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures yielded excellent outcomes. This approach is a useful alternative to the deltopectoral or the deltoid splitting approaches in the treatment of proximal humeral fractures.

• 出版日期2017-11