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Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoid-splitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures
Clinics in Shoulder and Elbow 2018;21:220-226
Published online December 1, 2018
© 2018 Korean Shoulder and Elbow Society.

Young-Min Noh, Dong Ryul Kim, Chul-Hong Kim1, Seung Yup Lee

Department of Orthopaedic Surgery, Dong-A University Hospital, 1Department of Shoulder Clinic, Mirae Hospital, Busan, Korea
Correspondence to: Young-Min Noh
Department of Orthopaedic Surgery, Dong-A University Hospital, 26 Daesingonwon-ro, Seo-gu, Busan 49201, KoreaTel: +82-51-240-5166, Fax: +82-51-254-6757, E-mail: thugdoc@naver.com, ORCID: https://orcid.org/0000-0001-7149-7526
IRB approval: Dong-A University Hospital (DAUHIRB-18-126).
Received May 28, 2018; Revised July 17, 2018
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Background: This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures.
Methods: From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >5째 loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated.
Results: In all cases, complete union was achieved. The ASES and VAS scores were improved to 85.4 짹 2.1 and 3.2 짹 1.3, respectively. Twelve patients (75.0%) had greater than a 5째 change in NSA; the average NSA change was 3.8째. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a <100째 active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit.
Conclusions: Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.
Keywords : Shoulder fractures; Allografts; Fibula; Minimally invasive surgical procedures; Range of motion