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Anterolateral deltoid-splitting ORIF may avoid AVN in proximal humerus fractures
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A minimally invasive anterolateral deltoid-splitting approach for open reduction and internal fixation with locking plate osteosynthesis may offer better outcomes for patients with intra-articular proximal humeral fractures compared with a standard deltopectoral approach, according to recently presented results.
Volodymyr Kovalchuk, MD, and colleagues, from Ukraine, observed advantages in terms of functional outcome, speed of recovery and health-related quality of life (HRQoL) for patients who underwent open reduction and internal fixation (ORIF) with locking plate osteosynthesis via a minimally invasive anterolateral (AL) deltoid-splitting approach compared with patients in whom ORIF was done with a deltopectoral (DP) approach.
“We think that we have proved the minimally invasive anterolateral approach is a safe and reproducible tool that will help to obtain results that are not inferior to a standard deltopectoral approach or can be even better with less chance of avascular necrosis (AVN) due to the higher probability of preserving the vascularity,” Kovalchuk told Orthopaedics Today Europe.
Minimally invasive vs traditional ORIF
The multicenter, controlled trial included 175 patients randomized into an AL deltoid-splitting approach group (83 patients) or a DP approach group (92). The investigators used Constant scores, DASH scores and HRQoL based on the patients’ EuroQol-5D scores as the primary outcomes.
They found the Constant scores were consistently higher in the AL group than the DP group at all follow-up visits; 72.1 points and 65.4 points, respectively (P < .05). The final scores were reached faster in the AL group than the DP group, which meant the AL approach provided a more rapid return to function, Kovalchuk said.
Better function
The investigators found the AL group had 43° mean shoulder external rotation and 39° mean internal rotation, which were both significantly better than in the DP group, which had 31° mean external rotation and 28° mean internal rotation (P < .05 for both).
“We think higher functional outcomes with the AL approach is because it is minimally invasive and more anatomical. With it we have an excellent exposure of the greater tuberosity and rotator cuff, which is essential for shoulder function. The plane of approach and the plane of reduction are in line (parallel), which is very handy and not like the DP approach, where they are perpendicular,” Kovalchuk said.
“To reduce tuberosities, we need to pull laterally and down with sutures (like a rein when we drive a horse), and it is very handy with this approach. Also, we do not need to cut the subscapularis or osteotomize the lesser tuberosity when it is not fractured to see the anatomical neck, which is a big plus for us.”
The minimally invasive AL deltoid-splitting approach results in excellent primary outcomes and allows for significantly lower AVN rates compared with the conventional DP approach, according to the investigators. – by Robert Linnehan
- Reference:
- Ankin M, et al. Poster #3586. Presented at: EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- Volodymyr Kovalchuk, MD, can be reached at the P.L. Shupyk National Medical Academy of Postgraduate Education, 9, Dorogozhytska St., Kiev, 04112, Ukraine; email: volodymyr.kovalchuk@gmail.com.
Disclosure: Kovalchuk reports no relevant financial disclosures.