Short-term clinical efficacy of modified anterior subacromial approach plate internal fixation in the treatment of valgus impacted proximal humeral fractures
10.3760/cma.j.cn121113-20231213-00396
- VernacularTitle:改良肩峰前下双切口钢板内固定治疗外展嵌插型肱骨近端骨折的早期疗效
- Author:
Youyou YE
1
;
Zhangjian YU
;
Yanbin LIN
;
Yan ZHUANG
;
Yangkai XU
;
Guosheng XIONG
;
Shaochen TU
Author Information
1. 福州市第二总医院创伤骨科（福建医科大学临床医学部），福州 350007
- Keywords:
Shoulder fractures;
Fracture fixation, internal;
Treatment outcome;
Surgical approach
- From:
Chinese Journal of Orthopaedics
2024;44(7):477-484
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy of modified anterior subacromial approach plate internal fixation for three- or four-part valgus impacted proximal humeral fractures.Methods:A retrospective analysis of 35 patients treated between November 2018 and November 2021 at Fuzhou Second General Hospital was performed, including 15 males and 20 females aged 61.7±7.8 years (range: 40 to 73 years). Patients were classified under the Neer system; 17 had 3-part fractures and 18 had 4-part fractures. The modified approach accessed the fracture site via the natural interval of the deltoid anterior bundle, facilitating fracture reduction and fixation using a plate. Operative time, incision length, intraoperative fluoroscopy time, follow-up duration, Constant-Murley score, fracture healing time, visual analogue scale (VAS) for pain, and humeral neck-shaft angle were assessed. Intraoperative and postoperative complications were also recorded.Results:All patients underwent successful surgery, with an average incision length of 8.1±0.3 cm (range, 7.6-9.0 cm) and intraoperative fluoroscopy time of 6.6±0.3 seconds (3-part fractures: 6.3±0.2 s, 4-part fractures: 6.8±0.2 s, t=6.350, P<0.001). Follow-up averaged 22.1±5.8 months (range, 14-31 months). Fracture healing occurred in 11.8±1.4 weeks (range, 10-15 weeks). At the final assessment, the VAS score was 1.6±0.7 (range, 1-3), the Constant-Murley score was 89.6±2.9 (range, 84-95), and the humeral neck-shaft angle was 133.4°±3.1° (range, 128°-138°; 3-part fractures: 133.6°±3.5°, 4-part fractures: 133.3°±2.8°, t=0.288, P=0.075). No complications such as avascular necrosis of the humeral head, varus collapse of the fracture site, or axillary nerve injury were recorded. Conclusion:The modified anterior subacromial approach plate internal fixation is a minimally invasive, safe, and effective treatment for valgus impacted three- and four-part proximal humeral fractures, demonstrated by excellent surgical outcomes and absence of major complications.
