title: Biological osteosynthesis of complex proximal humerus fractures: surgical technique and results from a prospective single center trial.
abstract: BACKGROUND
  Locked plating for complex proximal humerus fractures through a deltopectoral incision can be difficult due to the fracture morphology and need for fixed angle screws. Although good results have been reported with the deltopectoral approach; technical difficulties, excessive soft tissue stripping and fears of avascular necrosis have lead to the use of minimal access techniques.
  
  
  METHODS
  Fifteen patients with three or four part fractures were treated by locked plating through a mini-invasive lateral trans-deltoid approach. All patients were relatively young with good bone quality and had sustained a high-velocity injury. Initial closed reduction was attempted in all patients, but majority of the patients (9/15) required open reduction to achieve a satisfactory reduction.
  
  
  RESULTS
  Union was achieved in all patients. All fractures united with an acceptable alignment. There were no incidences of axillary nerve palsy. There were no incidences of hardware failure or loss of reduction. There were no incidences of avascular necrosis at 1-year follow-up. The mean normalized constant score at last follow-up was 85.24.
  
  
  CONCLUSIONS
  Locked plating through lateral trans-deltoid incision may offer a better alternative to the deltopectoral approach in these complex fractures where locked plating is contemplated. It respects the fracture biology, allows ease in placement of the locking plate and angle stable screws and offers a stable construct with less surgical morbidity.
authors.affiliation: Parvathy Ortho Hospital, No: 8, Sakthi Villa Apartments, Gandhi Road, Gill Nagar, Choolaimedu, Chennai 600094, Tamilnadu, India. gavaskar.ortho@gmail.com
authors.forename: Ashok S
authors.initials: AS
authors.lastname: Gavaskar
authors.forename: S
authors.initials: S
authors.lastname: Muthukumar
authors.forename: Naveen
authors.initials: N
authors.lastname: Chowdary
mesh_terms: D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome