Operative Treatment of Proximal Humeral Fracturedislocations Through an Anterolateral Deltoid Split Approach

Abstract

Background: Proximal humeral fracture-dislocations (PHFD) are a special entity in proximal humeral fracture<br />treatment. The aim of this study is to present our minimally invasive plate osteosynthesis (MIPO) technique through<br />an anterolateral deltoid split approach. In addition, we performed a retrospective cohort study analyzing the patient<br />reported functional outcome and complications.<br />Methods: A single center cohort study was performed. All patients operated through a deltoid split approach for PHFD<br />between 2009 and 2016 were eligible for inclusion. The primary endpoint was subjective shoulder function measured with<br />QuickDASH and subjective shoulder value (SSV). Secondary endpoints were complications and implant-related irritation.<br />Results: 28 patients were included. The mean age was 49 (SD ± 10.3). The mean follow-up was 48 months (SD ±<br />23.7). The mean QuickDASH score was 6.8 (SD ±7.8) and the mean SSV was 86 (SD ±14.6). Four patients had a<br />conversion into a reversed arthroplasty (14%), one patient (4%) a shortening of secondary perforated screws, four<br />patients an early re-osteosynthesis (14%), four patients (14%) developed an AVN and in one patient damage of the<br />axillary nerve was observed. 21 patients (75%) had their implant removed.<br />Conclusion: Patient reported functional results after humeral head preservation and internal fixation of PHFDs through<br />an anterolateral deltoid spilt approach are promising. However, there is a high rate of re-operations either because of<br />complications or for implant removal. Comparing our data to literature these rates are not depending on the approach chosen.<br />Level of evidence: IV