Abstract
The purpose of this study was to evaluate the functional and radiological outcome of proximal humeral fractures treated by minimally invasive plate osteosynthesis (MIPO) via an anterolateral acromial approach, which was recently reported as an alternative to open reduction and internal fixation via a deltopectoral approach.
In 2008, five patients (4 males and 1 female, mean age 62.6 years) were considered to be candidates for MIPO, and we treated them with a proximal humeral internal locking system (PHILOS). At the final follow-up (mean 8.9 months after surgery), the average shoulder flexion was 144 degrees, shoulder abduction 126 degrees, and JOA score 87.6. One patient had delayed union, which resulted in varus deformity postoperatively.
Reduction and internal fixation of proximal humeral fractures can be achieved using MIPO employing the same incision as that with an intramedullary nail, without invasion of the rotator cuff. However, because of the risk of axillary nerve injury, an inferomedial screw cannot always be applied to prevent varus deformity. Therefore we conclude that adaptation for MIPO should only be considered in patients whose age makes them unsuitable for use of an intramedullary nail, and in whom medial support can be obtained easily.
