Plate fixation of proximal humerus fractures using the minimally invasive anterolateral delta split approach.

OBJECTIVE: Minimally invasive plate osteosynthesis of proximal humerus fractures via an anterolateral delta split approach.

INDICATIONS: All proximal humerus fractures classified as 11-A1-3, 11-B1-2 (B3), and 11-C1-2 (C3) according to the AO/OTA system.

CONTRAINDICATIONS: Head split and closed irreducible dislocation type fractures, fractures with primary neurovascular impairment, and fractures in children with open growth plate.

SURGICAL TECHNIQUE: Beach chair position. Anterolateral delta split approach. Maintain rotator cuff insertions with nonabsorbable sutures. Reduction and K-wire retention of the tuberosities to the head fragment. Establish a tunnel along the anterolateral aspect of the proximal humerus with a blunt instrument (e.g., elevatorium). Attachment of the rotator cuff sutures to the corresponding plate holes of a 5-hole PHILOS® plate. Insertion of the plate underneath the deltoid muscle along the prepared tunnel. Preliminary fixation of the plate to the humerus head. Distal alignment of the plate and preliminary fixation. Reduction of the fracture onto the plate with a cortical screw in the shaft segment. Definitive plate fixation in the shaft and head segment. The nonabsorbable sutures are then tightened onto the plate.

POSTOPERATIVE MANAGEMENT: Immediate guided active exercise is encouraged. Weight bearing is increased according to radiological signs of consolidation.

RESULTS: In a prospective evaluation from 2003-2006, 29 patients (8 male and 21 female) with a mean age of 64 years (16-91 years) were analyzed. The mean follow-up time was 12 months (6-32 months). The operation was accomplished in 75 min (55-155 min) with an image intensifier time of 160 s (48-807 s). All fractures healed in a timely manner. The median Constant score reached 78 points (28-93 points). In one case (3%), clinical evidence of a lesion of the anterior branch of the axillary nerve was found.