Comparison between minimally invasive deltoid-split and extended deltoid-split approach for proximal humeral fractures: a case-control study.

BACKGROUND: With the rapid aging of the population, the incidence of proximal humeral fracture (PHF) has increased. However, the optimal method for open reduction and internal fixation (ORIF) remains controversial. METHODS: We performed a retrospective analysis of patients with PHF who underwent locking plate internal fixation at our institution from January 2016 to December 2018. Patients were divided into two groups based on the surgical approach used: an expanded deltoid-split approach group (ORIF group) and minimally invasive deltoid-split approach group (minimally invasive percutaneous plate osteosynthesis, [MIPPO] group). The groups were compared in terms of demographic and perioperative characteristics, and clinical outcomes. RESULTS: A total of 115 cases of PHF were included in our study, of which 64 cases were treated using the minimally invasive deltoid-split approach and 51 using the extended deltoid-split approach. Fluoroscopy was performed significantly less frequently in the ORIF group and the surgical duration was shorter. However, the postoperative visual analogue scale (VAS) pain score and duration of postoperative hospital stay were significantly higher compared to the MIPPO group. Moreover, secondary loss was significantly less extensive in the ORIF group compared to the MIPPO group, while there was no significant group difference in fracture healing time, Constant shoulder score, or complications at the last follow-up visit. CONCLUSIONS: The clinical outcomes associated with both the minimally invasive and extended deltoid-split approaches were satisfactory. The data presented here suggest that the extended deltoid-split approach was superior to the minimally invasive deltoid-split approach in terms of operational time, fluoroscopy, and secondary loss of reduction, while the minimally invasive approach was superior in terms of postoperative pain and hospital stay. Accordingly, neither procedure can be considered definitively superior; the optimal surgical procedure for PHF can only be determined after full consideration of the situation and requirements of the individual patient.

[Case-control study on treatment of distal tibiofibula fractures with modified anterolateral or traditional approach].

OBJECTIVE: To explore therapeutic effects of modified anterolateral approach and traditional approach in treating distal tibiofibula fractures. METHODS: From September 2009 to December 2012,45 patients with distal tibiofibula fractures were performed reduction and interal fixation with modified anterolateral and traditional approaches. According to Ruedi-All-gower classification, 12 cases were type I ,26 cases were type II, 7 cases were type III. Among 45 patients,there were 16 males and 7 females with an average age of (36.3 +/- 7.2) years old (ranged from 23 to 47) years old in advanced group; while there were 14 males and 8 females with an average of (33.8 +/- 6.4) years old (ranged from 25 to 45) in tradtional group. Operation time, blood loss, complications of incision were compared, and AOFAS scores were evaluated. RESULTS: All patients were followed up from 6 to 36 months with an average of 21.7 months. In traditional group, operation time was (74.7 +/- 9.9) min, blood loss was (94.4 +/- 10.4) ml, and (73.7 +/- 10.0) min, (100.8 +/- 12.1) ml in advanced group,there was no significant meaning between two groups (P > 0.05); complications of insicion of advanced group was better than that of traditional group (chi2 = 4.078, P < 0.05); AOFAS score in advanced group (86.1 +/- 9.4) was better than that of traditional group, and had significant meaning (t = 3.787, P < 0.05). CONCLUSION: Modified anterolateral group,which has advantages of rapid recovery, less complications, is a good choice for closed distal tibiofibula fractures.