Locked Plate Fixation of Proximal Humeral Fractures Through an Extended Deltoid Split Approach with Use of a Shoulder Strap Incision.

Abstract

The shoulder strap approach involves an anterolateral deltoid split with use of an inverted U incision, providing excellent lateral exposure for locked plate fixation of complex proximal humeral fractures. Proper positioning of the image intensifier is important for uninterrupted fluoroscopy. The tip of the acromion is a useful landmark and serves as the proximal extent of the incision. Raise a broad-based full-thickness fasciocutaneous flap. Split the deltoid anteriorly to minimize the chances of denervation. Leave a cuff of deltoid muscle to protect the axillary nerve. The cuff sutures are helpful in reduction of the proximal fracture segments and improve stability of three and four-part fractures. Avoid varus reduction and reestablish the relationship between the humeral head and the greater tuberosity. Proper plate positioning is important to maximize the possibility of using all proximal screw options and to minimize chances of impingement. As is necessary with all locked internal fixators, reduce the fracture before fixing the plate; the order of fixation may vary with the type of fracture. In our study of fifty patients with a displaced three or four-part fracture treated with this approach, all flaps healed well without any necrosis and no infections were seen.IndicationsContraindicationsPitfalls & Challenges.