Academic Journal of Second Military Medical University (第二军医大学学报) 2015/36:12 PP.1344-1347
Objective To evaluate the feasibility and clinical outcomes of minimally invasive treatment via anterolateral acromial approach (ALA) for severely impacted valgus fractures of the proximal part of the humerus. Methods From June 2011 to May 2013, a total of 20 patients with severely impacted valgus proximal humeral fracture were treated through ALA in a minimally invasive manner. Direct reduction, bone grafting, reconstruction of the rotator cuff insertion and Proximal Humerus Internal Locking System (PHILOS) planting were well carried out. Systematic rehabilitation exercise of the shoulder joint was performed postoperatively. Results All the patients were followed-up for at least one year, with an average of (15±3) months (range 12~36 months). No axillary neurapraxia occurred that could be attributed to the surgical approach. All fractures healed within 6 months, and the average Constant-Murley score at 1 year was (83.0±1.5) (range 79.0 to 89.5) during a 12-month follow-up. There was no internal fixation failure or avascular necrosis (AVN) of humeral head during follow-up. Conclusion Treatment of severely impacted valgus proximal humeral fractures with minimally invasive ALA through percutaneous plating PHILOS can avoid the injury of nerve and vascular, reduce the dissection of soft tissue, avoid damage to the residual blood supply of the humeral head and achieve stable fixation, benefiting early function recovery.
 Court-Brown C M, Garg A, McQueen M M. The epidemiology of proximal humeral fractures[J].Acta Orthop Scand, 2001, 72: 365-371.
 Jakob R P, Miniaci A, Anson P S, Jaberg H, Osterwalder A, Ganz R. Four-part valgus impacted fractures of the proximal humerus [J].J Bone Joint Surg Br, 1991, 73:295-298.
 Court-Brown C M, Cattermole H, McQueen M M. Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment[J].J Bone Joint Surg Br, 2002, 84:504-508.
 Robinson C M, Page R S. Severely impacted valgus proximal humeral fractures. Results of operative treatment[J].J Bone Joint Surg Am, 2003, 85-A:1647-1655.
 DeFranco M J, Brems J J, Williams G R Jr, Iannotti J P. Evaluation and management of valgus impacted four-part proximal humerus fractures[J].Clin Orthop Relat Res, 2006, 442:109-114.
 Gardner M J, Griffith M H, Dines J S, Briggs S M, Weiland A J, Lorich D G. The extended anterolateral acromial approach allows minimally invasive access to the proximal humerus[J].Clin Orthop Relat Res, 2005(434):123-129.
 Constant C R, Murley A H. A clinical method of functional assessment of the shoulder[J].Clin Orthop Relat Res, 1987(214):160-164.
 Sun J C, Li Y L, Ning G Z, Wu Q, Feng S Q. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate[J].Eur J Orthop Surg Traumatol, 2013, 23:699-704.
 Robinson C M, Longino D, Murray I R, Duckworth A D. Proximal humerus fractures with valgus deformity of the humeral head: the spectrum of injury, clinical assessment and treatment[J].J Shoulder Elbow Surg, 2010, 19:1105-1114.
 Robinson C M, Page R S. Severely impacted valgus proximal humeral fractures[J].J Bone Joint Surg Am, 2004, 86-A Suppl 1(Pt 2):143-155.
 Röderer G, Erhardt J, Graf M, Kinzl L, Gebhard F. Clinical results for minimally invasive locked plating of proximal humerus fractures[J].J Orthop Trauma, 2010, 24:400-406.
 刘 杰, 李少华, 李振华, 王建广, 杨春喜, 张 磊, 等. 经皮微创新型锁定钢板治疗老年肱骨近端骨折的病例对照研究[J]. 中国骨伤, 2013, 26:4-8.
 Merolla G, Nastrucci G, Porcellini G. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique[J].Transl Med UniSa, 2013, 6:16-28.
 Cadet E R, Ahmad C S. Hemiarthroplasty for three- and four-part proximal humerus fractures[J].J Am Acad Orthop Surg, 2012, 20:17-27.
 Gardner M J, Boraiah S, Helfet D L, Lorich D G. The anterolateral acromial approach for fractures of the proximal humerus[J].J Orthop Trauma, 2008, 22:132-137.
 Gardner M J, Voos J E, Wanich T, Helfet D L, Lorich D G. Vascular implications of minimally invasive plating of proximal humerus fractures[J].J Orthop Trauma, 2006, 20:602-607.
 Wallace M J, Bledsoe G, Moed B R, Israel H A, Kaar S G. Relationship of cortical thickness of the proximal humerus and pullout strength of a locked plate and screw construct[J].J Orthop Trauma, 2012, 26:222-225.
 Gardner M J, Griffith M H, Dines J S, Lorich D G. A minimally invasive approach for plate fixation of the proximal humerus[J].Bull Hosp Jt Dis, 2004, 62(1-2):18-23.