Efficacy of open reduction and locking plate fixation via subacromial anterolateral approach for proximal humerus fracture / 中华创伤杂志

ABSTRACT

Objective@#To investigate the clinical efficacy of subacromial anterolateral small incision approach with open reduction and internal fixation with proximal humeral locking system (PHILOS) for proximal humeral fractures.@*Methods@#A retrospective case-control study was conducted to analyze the complete medical records of 76 patients with proximal humeral fractures admitted to the Department of Traumatic Surgery, Fujian Provincial Hospital from April, 2013 to December, 2017. There were 22 males and 54 females, aged from 25 to 89 years [(60.4±16.4)years]. All patients had closed fractures. According to Neer classification, there were 12 patients of type II, 46 patients of type Ⅲ, and 18 patients of type IV. The duration from injury to operation ranged from 1 to 10 days [(4.4±1.9)days]. All patients received treatment of open reduction fixation with PHILOS. Forty patients received subacromial anterolateral small incision approach with percutaneous interactive reduction and internal fixation of humerus head and humerus shaft, including four patients of Neer type II, 26 patients of type III, and 10 patients of type IV (minimally invasive group). Thirty-six patients received the deltopectoral approach with reduction and internal fixation, including eight patients of type II, 20 patients of type III, and 8 patients of type IV (conventional group). The total length of incision, the operation time, intraoperative blood loss, hospitalization time, review of the neck angle with X-ray 1 week after surgery, and the fracture healing after 6 months, the ipsilateral Neer shoulder joint function score at 6 months after surgery and complications were compared.@*Results@#All patients were followed up for 3-12 months [(9.2±1.7)months], and there were six patients lost to the follow-up including four of the minimally invasive group and two of the conventional group. In the minimally invasive group and the conventional group, the total length of incision was 6.0(6.0, 6.8)cm and 11.5(10.0, 15.0)cm ( P<0.01), the operation time was (122.2±31.8)minutes and (136.9±36.6)minutes ( P>0.05), the intraoperative blood loss was 100(80, 150)ml and 175(100, 200)ml (P<0.01), the hospitalization time was (15.3±8.3)days and (16.2±5.1)days (P>0.05), the neck-shaft angle was (134.7±2.5)° and (134.6±2.6)°(P>0.05). A total of 70 patients obtained good bone healing. At 6 months after operation, the Neer shoulder function score of the affected side in the minimally invasive group was excellent in 30 patients, good in four patients, and fair in two patients, with the excellent and good rate of 96%, and for conventional group the score was excellent in 20 patients, good in eight patients, and fair in six patients, with the excellent and good rate of 84%(P<0.05). There was no complication in the minimally invasive group, but axillary nerve injury was found in one patient in the conventional group.@*Conclusion@#For the proximal humerus fracture, compared with the traditional deltopectoral approach, the subacromial anterior lateral small incision approach with percutaneous humeral head and humeral shaft reduction and interal fixation has the advantages of smaller incision, less bleeding and better functional recovery, which is a minimally invasive and effective treatment.