title: A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures.
abstract: BACKGROUND
  Locking-plate osteosynthesis is a well-established treatment option for proximal humerus fractures. The standard approach is delta-pectoral, but few data using the minimally invasive antero-lateral delta-split approach exist. The aim of the study was to prospectively evaluate shoulder function and radiological outcome after a minimally invasive antero-lateral delta-split approach.
  
  
  METHODS
  From December 2007 to October 2010, 124 patients with proximal humerus fractures were treated with locking-plate osteosynthesis using a minimally invasive antero-lateral delta-split approach. Complete prospective clinical and radiographic data were available for 97 patients for a minimum 1-year follow-up period.
  
  
  RESULTS
  After a follow-up period of 18 ± 6 months, the patients achieved a mean absolute Constant score of the injured shoulder of 75 ± 11, equalling 91% of the contralateral shoulder Constant score (p < 0.01). Implant-related complications (e.g., screw perforation) were observed in seven patients (7.2%), and avascular necrosis occurred in eight patients (8.2%). Damage to the ventral branch of the axillary nerve was recorded in four cases (4%) without any clinical consequences. The mean delay between trauma and surgery was 0.5 days. The procedures were performed by a total of 16 surgeons who required an average of 73 ± 27 min of OR time and 108 ± 121 s of fluoroscopy time.
  
  
  CONCLUSIONS
  Minimally invasive osteosynthesis using angle-stable implants for proximal humerus fractures demonstrated good functional results. Compared to the literature, this minimally invasive procedure resulted in a shorter operation time and may have reduced the avascular necrosis rate.
  
  
  METHODS
  Level IIb, monocentric prospective cohort study.
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, CH-7000 Chur, Switzerland. yvespascal.acklin@ksgr.ch
authors.forename: Yves P
authors.initials: YP
authors.lastname: Acklin
authors.forename: Karl
authors.initials: K
authors.lastname: Stoffel
authors.forename: Christoph
authors.initials: C
authors.lastname: Sommer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D010020:Osteonecrosis; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome