Submit a video to the ota video library and 2020 showcase. How to make super easy gimbap, making gimbap from a to z. Deltopectoral approach to shoulder joint netter images. As incidence increases worldwide, further increased incidence for proximal humeral fractures can be expected as a result of an aging society. A cadaveric study on the anatomy of the deltoid insertion and.
Using this approach, we have performed 25 23 for acute fracture, 2 for nonunion internal fixations of the proximal humerus and 19 stemmed arthroplasties for humeral head fractures. This study aimed to evaluate the pros and cons of the minimally invasive lateral approach for the treatment of proximal humeral. However, many complications still occur with use of the phlp, such as avascular necrosis of. The anterosuperior approach for reverse shoulder arthroplasty. Omar al bardan only the paranoid survive 12,077 views. Group a consisted of a total of fiftysix patients of. Lateral approach to distal humerus approaches orthobullets. The average age of people who sustain a proximal humerus fracture is 6366 years.
The proximal humeral physis contributes approximately 80% of the growth of the humerus. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to. Stranger things david harbour originally wanted the role of eleven before he was chief jim hopper, actor david harbour was first interested in a very different role on the hit tv series stranger things. For displaced fractures that meet surgical indications, the traditional deltopectoral approach is the most common approach for plate fixation of proximal humeral. Open reduction, retention, and fixation of proximal. This video demonstrates the modified mclaughlin technique for a posterior fracture dislocation. Approach a deltopectoral or transdeltoid approach is recommended. Nov 17, 2019 in proximal humerus fractures, the severity is often described by how many of the major parts of the proximal humerus fracture are displaced. Debate exists over the optimal approach for addressing fractures of the proximal humerus. Aug 25, 2017 locked plate fixation of proximal humeral fractures through an extended deltoid split approach with use of a shoulder strap incision full video article. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary nerve.
Advantage of minimally invasive lateral approach relative to. Selected answer 27792 rt question 10 1 out of 1 points a. Advantage of minimally invasive lateral approach relative. The humerus is the longest and largest bone of the upper limb. Proximal humeral fracture classfication aoota classification is based on fracture location and presence of impaction, angulation, translation, or comminution of the fracture, as well as whether a dislocation is present. Surgeons may use nails, plates, and screws to secure pieces of bone together. Now for the first time ever, watch his audition tape for the role of.
An anterosuperior approach for proximal humeral fractures article in techniques in shoulder and elbow surgery 72. Thirtythree patients were treated through a deltopectoral approach and 37 through an anterolateral deltoidsplitting approach. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Jan 12, 2014 surgical approaches to distal humerus fractures dr. Autoplay when autoplay is enabled, a suggested video will automatically play next. You may not embed one of our images on your web page without a link back to our site. This approach has recently been popularized for the copeland resurfacing and delta reversegeometry prostheses. Surgical technique for open reductioninternal fixation of. The mean patient age was sd, 4 years, and the median followup was 11 months range, 1 to 78 mo. Abstract the minimal anterolateral acromial approach offers a less invasive access to the proximal humerus. External rotation is evident by greater tubercle visualized in full profile on the lateral aspect of humerus.
Anterior approach to the humerus orthopaedicsone articles. The standard deltopectoral approach is widely used for fixation of the proximal humeral fractures, and has been associated with damage to the critical branches of the anterior and posterior circumflex vessels. The incision should begin just above the coracoid process. Oct 11, 2019 contraindications for repair of proximal humerus fractures include inability to tolerate the procedure medically and lack of clearance for surgery through the primary care physician or specialty consultants. A proximal humerus fracture in a young child may be a sign of child abuse. Dec 11, 20 proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The fracture site was identified and fragments were mobilized and the humeral head fragments removed. For displaced fractures that meet surgical indications, the traditional deltopectoral approach is the most common approach for plate fixation of proximal humeral fractures. Proximal humerus and lateral 23 of clavicle and upper scapula, including relationship of the humeral head to the glenoid cavity.
Initially, treatment of proximal humerus fractures consisted of closed reduction, traction, casting, and abduction splints. One of the structures at risk during this approach is the axillary nerve. The deltopectoral groove is easier to see than to feel. Computerized tomography confirms the articular impression fractures of the proximal humerus. The main advantages of the deltopectoral approach are the preservation of the deltoid muscle, exposure of the lower pole of the glenoid to facilitate glenoid implant positioning, possibility of inferior extension to control the proximal humerus, and ability to perform a latissimus dorsi transfer as described by boileau et al.
The deltopectoral approach is commonly performed during shoulder surgery. Deltopectoral approach for total shoulder replacement vumedi. At times, the approach is limited proximally or distally by the deltoid attachments. Step 1 surgical approach the patient is placed in the beachchair position. The axillary nerve an is reported to be one of the most commonly injured nerves during surgical procedures of the shoulder. Live reverse total shoulder arthroplasty using a deltopectoral approach. Through a deltopectoral approach, the lesser tuberosity along with the subscapularis tendon was transferred into the defect. Twopart proximal humerus fracture 66 yo male m1447 three part proximal humerus fracture 83 yo female m1603. Start a longitudinal incision over the tip of the coracoid process of the scapula, extend it distally and laterally in the line of the deltopectoral groove to the insertion of the deltoid muscle on the lateral aspect of the humerus, about halfway down its shaft. This plate addresses complex fractures of the proximal humerus.
An anterosuperior approach for proximal humeral fractures. Pain specialists at the cleveland clinic discuss optimal therapies, opioid alternatives, and lifestyle alterations for treating chronic pain, which affects at least 50 million americans. In this prospective randomized study, we aimed to investigate whether the deltoidsplit approach is superior to the deltopectoral approach with regard to 1. Orif with intramedullary nail for a proximal humerus fracture. Pectoralis major medial and lateral pectoral nerves. Surgical treatment of osteochondroma of the proximal humerus.
Locked plate fixation of proximal humeral fractures through. The optilock upper extremity plating system is intended for fixation of fractures and osteotomies. Fourpart fracture dislocation of the proximal humerus. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. This article is from the open orthopaedics journal, volume 5.
Surgical treatment for a proximal humerus fracture. Oct 11, 2019 the authors preferred technique is an open reduction through the deltopectoral approach using a precontoured proximal humerus locking plate for fixation. Buecking et al reported an average time taken for surgery in deltopectoral approach was. Learn about the humerus deltopectoral approach, an online 3d video based course, accredited by the royal college of surgeons of england. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. In older children and adolescents proximal humerus fractures frequently occur in the setting of sports or trauma.
This is a retrospective case series of 31 pediatric patients with proximal humeral oce treated with surgical excision. Electrophysiological assessment of the deltoid muscle. Preoperatively all 44 patients had documented normal motor function of all three parts of deltoid muscle with intact sensory function of axillary nerve. Background the deltopectoral approach is a welldescribed surgical approach to the proximal humerus and glenohumeral joint. Comparison of lateral deltoid splitting and deltopectoral. The proximal humeral locking plate phlp is a recently developed fixedangle implant that is an option for open reductioninternal fixation of an unstable displaced proximal humeral fracture. Although a superolateral approach frequently is used in the setting of reverse shoulder arthroplasty for the treatment of rotator cuff tear arthropathy, this approach can also be used in the fracture setting, but access to.
Anterolateral approach for trauma shoulderdoc by prof. Optilock upper extremity plating system proximal humeral plates. Standard deltopectoral approach was used and dissection was carried down to the fracture site. For complex and unstable fractures locking proximal humerus plate. Surgical exposures of the humerus location procedure clinical example surgical approach concerns and limitations proximal total shoulder arthroplasty conventional or reverse prosthesis deltopectoral axillary nerve, anterior humeral circum. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a. Reverse shoulder arthroplasty for the treatment of proximal humeral frac. Reverse shoulder arthroplasty for the treatment of proximal.
Trauma vivas for the frcs pdf free download direct link. By extending the traditional approach, some proximal humerus fractures requiring a more posterior route can be treated. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Once this was done, the stem was prepared up to a size 10. Make a 10 to 15cm straight incision, following the line of the deltopectoral groove.
A cadaveric study on the anatomy of the deltoid insertion. Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures. The majority of 4part fracture dislocations are best managed by humeral head replacement, although open reduction and internal fixation in young patients with good bone quality may be considered. The purpose of this study was to objectively quantify the surface area of the humerus exposed using the deltopectoral dp and anterolateral acromial ala approaches and to compare visualized and palpable anatomic landmarks. There are four parts of the proximal humerus, so a displaced fracture can either be 2part, 3part, or 4part a nondisplaced fracture is, by definition, 1part. Up next choosing surgical approaches to proximal humerus fractures duration. Deltopectoral approach to the shoulder lennard funk manchester. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. This elearning course provides a step by step approach, lessons on objectives, preoperative information and postoperative complications, procedural anatomy and a test. It consists of a proximal end, a shaft and a distal end, all which contain important anatomical landmarks. The system is intended for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus, particularly in osteopenic bone. Compared to the conventional deltopectoral approach in the orif of a phf, the minimally invasive lateral approach has significant advantages in terms of lesser intraoperational surgery duration and.
Shoulder lateral deltoid splitting approach approaches. Surgical approaches to distal humerus fractures dr. A deltopectoral approach, passing outside of the cephalic. The ota is seeking several trauma surgical technique videos to complete the otas trauma video library. Various articles have reported successful outcomes using the phlp when compared with other implant designs. For shoulder arthroplasty and proximal humerus fracture fixation, the skin incision is placed somewhat lateral, but for open instability surgery, the skin incision is best placed along the line that connects the coracoid tip with the axillary fold.
In some cases, the broken proximal humerus must be surgically repaired or replaced. Using a modification of this approach, we describe its use in a group of patients requiring either internal fixation or hemiarthroplasty for proximal humeral fracture and the effect of this approach on the postoperative function on the axillary nerve and deltoid muscle. This is especially true in the case of revision surgery or treatment of proximal third humeral shaft fractures. The rotator cuff surrounding the proximal humerus is at high risk of being simultaneously injured by the fracture, which is a critical factor that leads to pain, engorgement, and limitation of motion of the shoulder after the operation. Overview provides access to the lateral proximal humerus, rotator cuff, and acromion. Several authors have concluded that elevating the anterior insertion of the deltoid or the lateral edge of the pectoralis is often required when plating the proximal humerus through a deltopectoral approach. By current concepts in joint replacement featuring gilles walch. The upper or proximal extremity of the humerus consists of the bones large rounded head joined to the body by a constricted portion called the neck, and two eminences, the greater and lesser tubercles. The humerus articulates with the scapula proximally at the glenohumeral joint so it participates in the movements of the shoulder.
Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures. Deltoidsplit or deltopectoral approaches for the treatment. Deltoid splitting approach was used by exploring the axillary nerve on group a patients as described by codman, and deltopectoral approach was used on group b patients. To avoid damaging the axillary nerve, do not split. The axillary nerve can be palpated at the lower margin of the incision. The anterolateral approach to the proximal humerus for. Orif with intramedullary nail for a proximal humerus.
Deltoidsplit or deltopectoral approaches for the treatment of displaced proximal humeral fractures. Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The use of precontoured proximal humerus locked plates has yielded excellent results, with enhanced fixation in osteoporotic bone. May 17, 2014 the standard deltopectoral approach is extremely versatile and makes it possible to achieve fracture reduction and fixation and to implant a prosthesis if necessary. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced.
Learn about the humerus deltoidsplit approach, an online 3d video based course, accredited by the royal college of surgeons of england. Proximal humerus fractures pediatric orthopaedic society of. When a 66yearold woman presents with a displaced 2part proximal humerus fracture, the authors weigh the advantages and disadvantages of closed versus open reduction. Despite the advantages described above, the most outstanding advantage of the minimally invasive approach is. This video demonstrates the steps for exposure of the glenohumeral joint and the performance of a total shoulder replacement. Jun 05, 2016 how to make super easy gimbap, making gimbap from a to z. Alright, now in this part of the article, you will be able to access the free pdf download of trauma vivas for the frcs pdf using our direct links mentioned at the end of this article.
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