JBJS essential surgical techniques · 2015
Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus.
СтатьяНазвание и аннотация: Перевод в очереди
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Spross C, Grueninger P, Gohil S, Dietrich M
Аннотация
INTRODUCTION: We describe the surgical technique for open reduction and internal fixation (ORIF) of proximal humeral fractures with a locking plate.
STEP 1 PREOPERATIVE PLANNING: To choose the right candidate, obtain a full understanding of the patient's fracture pattern, activity level and demands, and bone quality; be aware of predictors of complications and poor outcomes.
STEP 2 PATIENT POSITIONING: Place the patient in the beach-chair position with the arm draped free or in a hydraulic device with good access for the image intensifier.
STEP 3 APPROACH: The deltopectoral approach is generally preferred because of the exposure obtained, the possibility of distal extension, and the minimal risk of nerve injury.
STEP 4 REDUCTION AND FIXATION OF THE TUBEROSITIES THE KEY TO OBTAINING MARIONETTE-LIKE CONTROL: The control, reduction, and fixation of the tuberosities are crucial to restore the anterior-posterior force couple of the shoulder and must therefore be done properly no matter what the fracture pattern looks like.
STEP 5 FRACTURE REDUCTION: After carrying out Steps 1 through 4, perform the reduction techniques for the specific fracture type as described below for types that we think suitable for ORIF with a locking plate.
STEP 6 FIXATION IMPLANT-SPECIFIC CONSIDERATIONS: Plate length and positioning, humeral head screw placement, distal locking, confirming the screw tip position with the image intensifier, and securing the tuberosities.
STEP 7 TENOTOMY OR TENODESIS OF THE LONG BICEPS TENDON: Perform a biceps tenotomy if the biceps is displaced out of the groove by the fracture pattern or if you have to open the rotator interval.
STEP 8 WOUND CLOSURE: Do not close the deltopectoral interval.
STEP 9 REHABILITATION: As the failure rate of ORIF of proximal humeral fractures is high, do not force an active rehabilitation protocol.
RESULTS: In our analysis of 269 fractures followed for twelve months, we found that the Constant-Murley score (CMS) and Short Form-36 (SF-36) score improved continuously during the first six months postoperatively.IndicationsContraindicationsPitfalls & Challenges.
STEP 1 PREOPERATIVE PLANNING: To choose the right candidate, obtain a full understanding of the patient's fracture pattern, activity level and demands, and bone quality; be aware of predictors of complications and poor outcomes.
STEP 2 PATIENT POSITIONING: Place the patient in the beach-chair position with the arm draped free or in a hydraulic device with good access for the image intensifier.
STEP 3 APPROACH: The deltopectoral approach is generally preferred because of the exposure obtained, the possibility of distal extension, and the minimal risk of nerve injury.
STEP 4 REDUCTION AND FIXATION OF THE TUBEROSITIES THE KEY TO OBTAINING MARIONETTE-LIKE CONTROL: The control, reduction, and fixation of the tuberosities are crucial to restore the anterior-posterior force couple of the shoulder and must therefore be done properly no matter what the fracture pattern looks like.
STEP 5 FRACTURE REDUCTION: After carrying out Steps 1 through 4, perform the reduction techniques for the specific fracture type as described below for types that we think suitable for ORIF with a locking plate.
STEP 6 FIXATION IMPLANT-SPECIFIC CONSIDERATIONS: Plate length and positioning, humeral head screw placement, distal locking, confirming the screw tip position with the image intensifier, and securing the tuberosities.
STEP 7 TENOTOMY OR TENODESIS OF THE LONG BICEPS TENDON: Perform a biceps tenotomy if the biceps is displaced out of the groove by the fracture pattern or if you have to open the rotator interval.
STEP 8 WOUND CLOSURE: Do not close the deltopectoral interval.
STEP 9 REHABILITATION: As the failure rate of ORIF of proximal humeral fractures is high, do not force an active rehabilitation protocol.
RESULTS: In our analysis of 269 fractures followed for twelve months, we found that the Constant-Murley score (CMS) and Short Form-36 (SF-36) score improved continuously during the first six months postoperatively.IndicationsContraindicationsPitfalls & Challenges.