Kirschner wire into the proximal guide hole of the insertion guide below the rotator cuff so that the kirschner wire aims at the proximal joint surface. Greater tuberosity or humoral head position uncertain. Functional bracing of fractures of the shaft of the humerus. The full text of this article is available in pdf format. Part of the synthes locking compression plate lcp system. Proximal humerus, threepart fracture, fourpart fracture, surgical treatment, orif. The deltopectoral approach for exposure of the anterior and lateral shoulder region has been most commonly used for plating of the proximal humerus. Mar 17, 2016 plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive surgeons. Open reduction and internal fixation in proximal humerus fractures. Results of a prospective, multicenter, onservational study. The deltopectoral approach is commonly used for surgical treatment of proximal humerus fractures. Proximal humerus plating system is designed to provide intraoperative flexibility and efficiency to the surgical team.
Using a modification of this approach, we describe its use in a group of patients requiring either internal fixation or hemiarthroplasty for proximal humeral fracture and the effect of this approach on the postoperative function on the axillary nerve and deltoid muscle. An anterosuperior approach for proximal humeral fractures. The skin incision starts from the coracoid process and is slightly convex toward the medial side, extending distally as far as the insertion of the deltoid muscle on the lateral humeral. Shoulder arthroplasty for acute proximal humerus fracture em. Over 250,000 doctors use vumedi to improve patient care and grow their practice. The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral shoulder joint. However, accessing the lateral aspect of the proximal humerus using this approach requires extensive soft tissue dissection and retraction, as it is an indirect approach to the plating zone. At 12month followup, the average constant score was 70. Proximal humerus and lateral 23 of clavicle and upper scapula, including relationship of the humeral head to the glenoid cavity. Relevance thumbs up comments views newest oldest 15. A minimally invasive approach for plate fixation of the. However, the outcomes of humeral shaft fracture fixation using a medial approach are rarely reported. See data sheet ref 97223201500 for more specific instructions. Theses fractures are increasingly common in the over 60s age group.
The approach can be extended into an anterolateral approach to the humerus. Medial approach to treat humeral midshaft fractures. Despite the wide application of open reduction and internal fixation with locking plates for the treatment of proximal humeral fractures, the surgical. Proximal humerus non union acta of shoulder and elbow surgery. Delay of motion has deleterious effects on shoulder range of motion, pain, and function. Surgical exposures of the humerus the neurovascular and muscular anatomy about the humerus precludes the use of a truly safe fully extensile approach. Abduct arm slightly so there is no superimposition of proximal humerus over ribs. Indications shoulder arthroplasty proximal humerus fractures reconstruction of recurrent dislocations long head of the biceps injury septic glenohumeral joint. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Optilock upper extremity plating system proximal humeral.
Fixation of a proximal humerus fracture using a polyaxial locking. Michael j gardner orif of the proximal humerus through an anterolateral acromial approach. Advantage of minimally invasive lateral approach relative to. With respect to approach of proximal humerus fractures there has been a wide variation in. The plates feature combi holes that allow fixation with either. During the past several decades, the incidence of these fractures ap pears to be increasing with the increase in the proportion of older adults 2. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Nonunions of proximal humerus fractures can be disabling as a result of pain, deformity and instability, and are often found in geriatric patients with poor bone quality. Nonbridging external fixation for proximal humerus fractures. The pdf of the article you requested follows this cover page.
The posterior aspect of this part of humerus can be exposed. Unicameral bone cyst is the leading cause, as this lesion develops in the proximal humerus in 51% of cases. A lateral approach to the distal humerus following. The capital centre appears at 3 months of age at the latest, whereas the two other centres appear at 1 year of age and fuse between 3 and 5 years of age to produce the tuberosity ossification centre. By 3 weeks, active assisted rangeof motion and pendulum exercises may be initiated under the supervision of a physical therapist. Placement of a locking proximal humerus plate via a minimally invasive lateral transdeltoid approach is safe if the locking screws are limited to superior and inferior holes. Once the initial incision is made, develop the subcutaneous flap, locate and identify the cephalic vein. Whatever the type of prosthesis, implantation for proximal humerus fracture is a. External rotation is evident by greater tubercle visualized in full profile on the lateral aspect of humerus. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Proximal humerus is divided into four parts based on epiphyseal lines. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated.
Dec 11, 20 proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. Placing the plate at too high a level increases the risk of subacromial impingement. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a tricepsavoiding paramuscular technique. Surgical treatment of three and fourpart proximal humeral fractures. The anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. Proximal humerus fracture classifications shoulderdoc.
In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to 1. Surgical technique proximal humeral fracture plate system. Fracture of the proximal humerus is a common orthopaedic injury and is likely. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to 1 complication rate. Percutaneous plating of the proximal humerus request pdf. Indication the anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the abkrdaje approach. Deltoidsplit or deltopectoral approaches for the treatment. The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments such as those between the coracoid process of the scapula and the acromion, serve to both stabilize the glenohumeral articulation and provide for a. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Optilock upper extremity plating system proximal humeral plates. Case report axillary artery injury secondary to proximal. Approach the standard surgical approach for internal fixation of proximal humerus fractures is the interval between the deltoid and pectoral muscles proximally. Proximal humerus bone fractures overview verywell health. We prefer the anterolateral extended approach which gives better access to the tuberosities and a better cosmetic result.
Finally, among all pathological fractures, 40% involve the proximal humerus. Placing the plate too low can prevent the optimal distribution of screws in the humerus head and. The other tumours responsible for pathological phfs are aneurysmal bone cyst, nonossifying fibroma, fibrous dysplasia, and bone malignancies such as osteosarcoma 2. This nerve is at risk with proximal extension, as the nerve pierces the lateral septum in the distal third of the arm please rate topic. Learn about the distal humerus lateral approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. It then coursed distally along the external margin of the humerus and remained posterior to the lateral intermuscular septum until it emerged from the. Anatomical landmarks for the anterior deltopectoral approach are. A minimally invasive approach for plate fixation of the proximal. Fractures of the proximal humerus represent about 45 % of all fractures and are the third most common fractures in the elderly. Rarely, a posterior approach to the proximal third of the humerus is needed, as in this patient, whose case was just described. This video demonstrates in detail a novel technique for nonbridging external fixation of the proximal humerus. Extended paratricipital approach for intraarticular. The traditional deltopectoral approach for the anterior and. Review article metaanalysis comparing deltoidsplitting.
Lateral approach to distal humerus approaches orthobullets. Deltopectoral approach exposure is achieved through a 1012cm incision that starts at the clavicle and proceeds over the coracoid toward the deltoid insertion. A humerus fracture is a break of the humerus bone in the upper arm. Proximal humerus fractures in children and adolescents. Deltopectoral vs deltoid split approach for proximal humerus. Humerus and shoulder girdle positioning flashcards quizlet. In this age group most injuries are related to low injury falls. Proximal humeral shaft the periosteum is incised longitudinally to expose the upper part of the humeral shaft, just lateral to the insertion of the tendon of the pectoralis major. This is a case presentation and description of a surgical technique for open reduction and internal fixation of an intraarticular, fourpart proximal humerus f. The anterolateral approach to the proximal humerus for. Nov 17, 2019 a proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken.
Proximal humerus plating system is designed to minimize the risk of some of the complications commonly associated. Unstable proximal humerus rehab protocol active finger, hand, wrist, and elbow exercises are encouraged. The fracture is actually at the top of the arm bone the humerus. Case report axillary artery injury secondary to proximal humerus fractures. Unstable proximal humerus orthopaedic medical group of. Its upper surface is rounded and marked by three flat impressions. The aim of this study is to explore the management and outcomes of humeral midshaft fractures fixed through a medial incision. Proximal humerus plating system is designed to minimize the risk of some of the complications commonly associated with treating proximal humerus fractures by its design to. The incision should be in line with the deltoidpectoral interval. Indirect reduction maneuver and minimally invasive approach for. This is a case study of a 46 year old lady who sustained a displaced 3 part fracture of his proximal humerus.
Outcomes for surgical management for proximal humerus nonunion have been reported, with failure rates ranging from 9% to 20%4,8,10 an optimal surgical approach would provide adequate exposure of the fracture fragments and relevant anatomy while preserving the tissue viability with minimal dissection to achieve higher rates of union. Proximal fractures are classified into one of four types of fractures based on the displacement of the greater tubercle, the lesser tubercle, the surgical neck, and the anatomical neck, which are the four parts of the proximal humerus, with fracture displacement being defined as at least one centimeter of separation or an angulation greater. Anterior approach to the humerus orthopaedicsone articles. The head caput humeri, is nearly hemispherical in form. Proximal humeral fractures, metaanalysis, deltopectoral approach, deltoidsplitting approach introduction proximal humerus fractures constitute up to 5% of all adult fractures 1. Ncb proximal humerus surgical technique 5 not available in europe, middle east, and africa cable fixation options the following products from the zimmer cableready cable grip system are compatible with the ncb proximal humerus system. By extending the traditional approach, some proximal humerus fractures requiring a more posterior route can be treated. With no disruption of ligaments and no displacement, treated with simple sling. Oct 11, 2019 sudkamp et al evaluated the complication rate and functional outcome of 187 patients after orif of proximal humerus fractures using a locking proximal humerus plate.
There are two options when choosing the surgical approach for locking plate fixation to treat proximal humerus fractures phf. Evidencebased algorithm to treat patients with proximal humerus. Extend the skin incision down the deltopectoral groove. May 17, 2014 the standard deltopectoral approach is extremely versatile and makes it possible to achieve fracture reduction and fixation and to implant a prosthesis if necessary. The video details pearls in planning and techniques.
These plates are low profile, stainless steel and available in 2hole 75mm, 4hole 99mm, 6hole 123mm and 10hole 171mm lengths. There may be a decreased ability to move the arm and the person may present holding their elbow. Oct 10, 2016 proximal periarticular locking plates in proximal humerus fractures. Nov 30, 2017 lcp posterolateral distal humerus plates, with support and lcp medial distal humerus plate duration. Retract the cephalic vein laterally or medially, and open along the groove. There are relatively few studies examining the treatment of nonunions of the proximal third of the humerus and the ideal treatment and surgical approach remains unclear. The proximal humeral physis is composed of three ossification centres, for the head, lesser tuberosity, and greater tuberosity, respectively.
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