Complex proximal humerus fractures treated with locked plating utilizing an extended deltoid split approach with a shoulder strap incision.
OBJECTIVE
The goal of the study is to analyze the outcome and complications after locked plating of proximal humerus fractures with the extended deltoid split approach though a shoulder strap incision.


METHODS
Prospective.


METHODS
Tertiary care referral center.


METHODS
Fifty-two adult patients with a displaced 3 or 4 part proximal humerus fracture or fracture dislocation.


METHODS
Open reduction and locked plate osteosynthesis through an extended deltoid split approach using a strap incision.


METHODS
Electrophysiological assessment of axillary nerve function at 6 weeks and at 3, 6, and 12 months postoperatively in those patients in whom an abnormality was detected postoperatively. Functional outcome measurement using normalized Constant scores at 6 and 12 months. Other measures include radiological assessment and complications.


RESULTS
Traction injury to the anterior part of the axillary nerve was electrically evident but not clinically apparent in 4 patients. The normalized Constant score continued to show significant improvement 1 year post surgery, 67.3 ± 11.3 at 6 months and 80.2 ± 7.7 at 1 year (P = 0.001)). Union was obtained in all patients. Varus/valgus/tuberosity malreductions were seen in 8 patients. Loss of reduction was seen in 2 patients. Two patients had radiological evidence of avascular necrosis at 1-year follow-up.


CONCLUSIONS
Locked plating of proximal humerus fractures through an extended deltoid split approach using a shoulder strap incision provides satisfactory outcomes. Axillary nerve injury is the only limitation of the approach and can be minimized with careful identification and protection of the nerve throughout the procedure.


METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopedic Traumatology, Parvathy hospital, Chennai, India. gavaskar.ortho@gmail.com
Ashok S
AS
Gavaskar
Naveen
N
Chowdary
Samson
S
Abraham
D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012783:Shoulder Dislocation / Q000150:complications / Q000601:surgery*; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery*