Treatment of proximal humeral fractures with LPHP through a small incision on the anterolateral shoulder / 中华创伤骨科杂志

ABSTRACT

Objective To report the clinical results of the treatment of proximal humeral fractures with a locking proximal humeral plate (LPHP) through a small skin incision on the anterolateral shoulder. Methods In the period from May 2004 to June 2005, 17 cases of proximal humeral fractures were treated in our department. There were 3 Neer two-part fractures, 10 Neer 3-part ones and 4 Neer 4-part ones. Starting from 1.5cm anterior to the acromion, the skin was incised for 6 cm in length and the deltoid muscle was separated along the muscle fibers to expose the fracture fragments. Under direct vision the indirect reduction of the fracture was performed and the fragments were temporarily fixed with K-wires. The LPHP was inserted distally beneath the deltoid muscle and the position between the distal plate and the humeral shaft was adjusted through another small skin incision on the lateral upper arm. 4 locking screws were inserted to the proximal plate to fix the fracture fragments while screws were percutaneously inserted to the distal plate to fix it to the humeral shaft. Results This series experienced a primary wound healing, a mean operation time of (128?35) min, a mean intraoperative blood loss of 65?19 mL, and an average hospitalization of 4 days. A follow-up of mean 6.1 months, ranging from 3 months to 14 months, was performed in 12 cases of the 17 and revealed fracture union in all, with a mean healing time of 15.7 (ranging from 12 to 24) weeks. The final follow-up demonstrated a normal sensation on the lateral arms and a motion range in shoulder abduction of 80?to 150?and flexion of 80?to 160?. Conclusion The treatment of proximal humeral fractures by open reduction and internal fixation with LPHP through a small skin incision on the anterolateral shoulder has the advantages of simplifying operative maneuver, reducing tissue damage, decreasing blood loss, shortening bone healing time and improving functional recovery.