Standard deltopectoral approach was used and dissection was carried down to the fracture site. However, accessing the lateral aspect of the proximal humerus using this approach requires extensive soft tissue dissection and retraction, as it is an indirect approach to the plating zone. The skin incision starts from the coracoid process and is slightly convex toward the medial side, extending distally as far as the insertion of the deltoid muscle on the lateral humeral. Qualitative and quantitative anatomy of the proximal. Deltoidsplit or deltopectoral approaches for the treatment. Proximal humerus fracture repair with an intramedullary nail. Minimally invasive plate osteosynthesis with a locking. For complex and unstable fractures locking proximal. For complex and unstable fractures locking proximal humerus plate.
Electrophysiological assessment of the deltoid muscle after. An anterosuperior approach for proximal humeral fractures. For displaced fractures that meet surgical indications, the traditional deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. The proximal humeral locking plate phlp is a recently developed fixedangle implant that is an option for open reductioninternal fixation of an unstable displaced proximal humeral fracture. The pectoralis fascia is incised lateral to the tendon of the short. Thirtythree patients were treated through a deltopectoral approach and 37 through an anterolateral deltoidsplitting approach. Many surgeons are familiar with this procedure, but certain steps are still controversial. Deltopectoral and anterolateral detoidsplitting approaches for plate fixation of proximal humeral fractures are safe and. Close the deltopectoral groove, the subcutaneous tissues and the skin. The fracture site was identified and fragments were mobilized and the humeral head fragments removed. Dec 11, 20 proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society.
Learn about the humerus deltopectoral approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. The deltopectoral approach is a common surgical procedure for shoulder arthroplasty. Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. Functional outcomes for surgically treated 3 and 4part. The deltopectoral approach for exposure of the anterior and lateral shoulder region has been most commonly used for plating of the proximal humerus. By extending the traditional approach, some proximal humerus fractures requiring a more posterior route can be treated. A quantitative comparison of the deltopectoral approach and the. Lateral incision of the proximal humerus for the deltoid lift extensile approach. Php proximal humerus plate surgical technique youtube. The anterior deltopectoral approach to the proximal humerus. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary nerve. Its upper surface is rounded and marked by three flat impressions. This study retrospectively evaluated functional outcomes of locked plate fixation vs hemiarthroplasty in 57 patients with 3 and 4part proximal humerus fractures from 2003 to.
This article is conceived as a toolkit for the inexperienced surgeons, describing our. An evaluation of treatment options for medial, midshaft, and distal clavicle fractures. The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects. In vivo, manual rotation of the humerus following each exposure would. Read deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures. Deltopectoral approach to shoulder joint netter images. Proximal humeral fractures, metaanalysis, deltopectoral approach, deltoidsplitting approach introduction proximal humerus fractures constitute up to 5% of all adult fractures 1.
While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. Twopart proximal humerus fracture 66 yo male m1447 three part proximal humerus fracture 83 yo female m1603. The use of minimally invasive plate osteosynthesis mipo via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. Shoulder lateral deltoid splitting approach approaches. Deltopectoral vs deltoid split approach for proximal humerus. A 3 fold increase of proximal humeral fractures is expected by 2030 3. This prospective randomized study was performed to evaluate the clinical outcomes after osteosynthesis of proximal humeral fractures with a polyaxial locking plate using either the less invasive, deltoidsplit approach or the deltopectoral approach, specifically evaluating for differences in complication rate, function, and pain. Position plate the positioning of the philos long requires a partially lateral section of the deltoid muscle. Furthermore, excessive soft tissue stripping destroys the local blood supply and integrity of the deltoid, which may increase the risk of avascular necrosis and. As the most commonly used approach in the shoulder, deltopectoral approach is used for reduction and internal fixation of proximal humerus fractures, to treat bony glenoid injuries, shoulder.
Proximal humerus plating system is designed to minimize the risk of some of the complications commonly associated. Treatment and outcome of malignant bone tumors of the. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary ne. Overview this approach can be a fairly extensile exposure, allowing access to the anterior, medial, and lateral aspects of the shoulder. Electrophysiological assessment of the deltoid muscle. During the past several decades, the incidence of these fractures ap pears to be increasing with the increase in the proportion of older adults 2. Approach a deltopectoral or transdeltoid approach is recommended. If you would like a large, unwatermarked image for your web page or. Advantage of minimally invasive lateral approach relative to. Trauma vivas for the frcs pdf free download direct link. The purpose of this study was to objectively quantify the surface area of the humerus exposed using the deltopectoral dp and anterolateral acromial ala approaches and to compare visualized and palpable anatomic landmarks. Debate exists over the optimal approach for addressing fractures of the proximal humerus. This article is conceived as a toolkit for the inexperienced surgeons, describing. Deltopectoral approach to the shoulder lennard funk manchester.
Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Surgical approaches to distal humerus fractures dr. Surgical technique for open reductioninternal fixation of an. A quantitative comparison of the deltopectoral approach and the anterolateral acromial. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. Abstract the minimal anterolateral acromial approach offers a less invasive access to the proximal humerus. An anatomic study of the cephalic vein in the deltopectoral shoulder approach. Using a modification of this approach, we describe its use in a group of patients requiring either internal fixation or hemiarthroplasty for proximal humeral fracture and the effect of this approach on the postoperative function on the axillary nerve and deltoid muscle.
Proximal humerus plating system is designed to provide intraoperative flexibility and efficiency to the surgical team. Approach the standard surgical approach for internal fixation of proximal humerus fractures is the interval between the deltoid and pectoral muscles proximally. However, some authors have argued that this approach involves extensive soft tissue dissection and muscle retraction to gain adequate exposure to the lateral aspect of the. Question 1 10 out of 10 points case 1 operative report preoperative diagnosis. However, this approach provides limited exposure of the posterior aspect of the proximal humerus due to the pull of the cuff muscles and the lateral aspect where the plate is placed. Exposure of deltopectoral groove and cephalic vein identify the cephalic vein and preserve it during dissection. This approach has recently been popularized for the copeland resurfacing and delta reversegeometry prostheses. Feb 15, 2015 however, this approach provides limited exposure of the posterior aspect of the proximal humerus due to the pull of the cuff muscles and the lateral aspect where the plate is placed.
Indication the anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. To avoid damaging the axillary nerve, do not split. Qualitative and quantitative anatomy of the proximal humerus muscle attachments and the axillary nerve. The proximal humeral physis contributes approximately 80% of the growth of the humerus. Proximal humerus fractures pediatric orthopaedic society. Once this was done, the stem was prepared up to a size 10. This article is from the open orthopaedics journal, volume 5. The head caput humeri, is nearly hemispherical in form. However, many complications still occur with use of the phlp, such as avascular necrosis of. The anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. Approach the approach must normally be lengthened because of the plate. Humeral exposure of the anterior deltopectoral approach with ruler and area. The purpose of this study was to compare the outcome, complications and survival of the commonly used surgical reconstructions of the proximal humerus after intrarticular tumour resection in our hospital.
Iita pte q r muscu loskeleta i system report left proximal humerus fracture preoperative diagnosis. Schematic diagram for deltopectoral approach ds and deltoidsplit approaches dp. Learn about the humerus deltoidsplit approach, an online 3dvideobased course, accredited by the royal college of surgeons of england. A 66yearold sustained a left proximal humerus fracture. Article information, pdf download for the deltoid lift. Mar 21, 2019 the anterior deltopectoral approach can be used for almost any proximal humeral fracture treatment and is often the preferred approach. The standard deltopectoral approach is extremely versatile and makes it possible to achieve fracture reduction and fixation and to implant a prosthesis if necessary. To ensure usersafety and faster downloads, we have uploaded this. This corr insights is a commentary on the article deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures. In this article, we are sharing with our audience the genuine pdf download of trauma vivas for the frcs pdf using direct links which can be found at the end of this blog post. Lateral approach to distal humerus approaches orthobullets. Although most humeral shaft fractures can be treated nonoperatively, many patients do benefit significantly from surgical treatment. Pdf the optimal treatment for proximal humeral fractures is controversial.
Surgical exposures of the humerus location procedure clinical example surgical approach concerns and limitations proximal total shoulder arthroplasty conventional or reverse prosthesis deltopectoral axillary nerve, anterior humeral circum. Dec 11, 20 read deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures. The deltopectoral groove is easier to see than to feel. Satisfactory reduction of anatomical neck fractures eg, c1. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to. Anterior approach to the humerus orthopaedicsone articles. In addition, the approach can be extended both proximally and distally, providing the surgeon a dynamic exposure to the. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to 1. As the locking plate is positioned on the greater tuberosity and lateral proximal humeral, this technique offers direct access to the laterally fractured planes for the placement of a locking plate, which is considered a difficult procedure with the deltopectoral approach.
Over a 4year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. The cephalic vein is identified proximally and usually retracted laterally while exposing the deltopectoral plane. Start a longitudinal incision over the tip of the coracoid process of the scapula, extend it distally and laterally in the line of the deltopectoral groove to the insertion of the deltoid muscle on the lateral aspect of the humerus, about halfway down its shaft. This is the case for the management of subscapularis, where surgeons must choose between tenotomy and the lesser tuberosity osteotomy. A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus. Jan 16, 2015 the deltopectoral approach is a common surgical procedure for shoulder arthroplasty. Proximal humerus plating system is designed to minimize the risk of some of the complications commonly associated with treating proximal humerus fractures by its design to. The axillary nerve can be palpated at the lower margin of the incision. Surgical technique for open reductioninternal fixation of. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Jan 29, 2018 php proximal humerus plate surgical technique. A comparison of the radiographic and the clinical outcomes between two different surgical approachesdeltoid splitting and deltopectoral intervalon the proximal humerus fractures treated by locking compressive plate lcp, is done. Comparison study of different approach deltoid splitting. Jan 17, 2019 shoulder anterior deltopectoral approach.
Pdf background debate exists over the optimal approach for addressing fractures of. Advantage of minimally invasive lateral approach relative. The use of precontoured proximal humerus locked plates has yielded excellent results, with enhanced fixation in osteoporotic bone. Make a 10 to 15cm straight incision, following the line of the deltopectoral groove. A minimally invasive approach for plate fixation of the. Philos proximal humeral internal locking system plate length 90 mm, short, 3 shaft holes x41.
Deltoidsplit approach versus deltopectoral approach for proximal. Pectoralis major medial and lateral pectoral nerves. A cadaveric study on the anatomy of the deltoid insertion. Jan 12, 2014 surgical approaches to distal humerus fractures dr. The upper or proximal extremity of the humerus consists of the bones large rounded head joined to the body by a constricted portion called the neck, and two eminences, the greater and lesser tubercles. Annotations api oai service bulk downloads developers forum. You may not embed one of our images on your web page without a link back to our site. Fractures of the proximal part of the humerus represent almost 45% of all fractures. The incision should begin just above the coracoid process.
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