None listed
Conditions
Brief summary
Proximal humerus fractures are increasingly common in societies with maturing populations. These fractures are not simple to treat with most being treated nonsurgically. If surgery is contemplated , a variety of surgical options exist including suture fixation, plating, nailing and arthroplasty. Locking plate technology has shown promising results especially in the setting of elderly patients with osteoporotic bone. More recently, minimally invasive techniques to apply these locking plates have been described. The two main approaches to internally fix these fractures has been the standard deltopectoral approach and the limited deltoid splitting approach. The potential advantages of a limited deltoid splitting approach are less soft tissue dissection and a faster postoperative recovery. However, standard open reduction allows direct anatomic reduction of the fracture at the expense of a larger surgical dissection. To our knowledge, there have been no randomised controlled trials comparing these 2 approaches. Our primary aim is to compare clinical outcomes following standard open reduction internal fixation via a deltopectoral approach versus a minimally invasive closed reduction and internal fixation via a limited deltoid splitting approach for treatment of displaced proximal humeral fractures.
Interventions
The minimally invasive technique involves reduction of the fracture using closed methods and temporary fixation with k-wires to hold the fracture together. A small incision and approach is then performed directly through the deltoid muscle and a locking plate is placed down onto the bone via this small incision. It is then locked into place with a series of small stab incisions which allow placement of screws through the plate to hold it on the bone. The potential advantage is less surgical diss
The minimally invasive technique involves reduction of the fracture using closed methods and temporary fixation with k-wires to hold the fracture together. A small incision and approach is then performed directly through the deltoid muscle and a locking plate is placed down onto the bone via this small incision. It is then locked into place with a series of small stab incisions which allow placement of screws through the plate to hold it on the bone. The potential advantage is less surgical dissection with a faster recovery time and less disruption of the fracture fragments which may lead to better rates of fracture union. This duration of this procedure is approximately 90-120 minutes.
Sponsors
Auckland District Health Board
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to No maximum
Healthy volunteers
No
Inclusion criteria
skeletal maturity able to sign consent and comply with treatment
Exclusion criteria
compound injuries previous surgery to upper limb previous known upper limb dysfunction neuromuscular disorder affecting upper limb significant neurological deficit at time of injury pathologic fracture major medical comorbidities precluding surgical intervention
Outcome results
None listed