PURPOSE OF THE STUDY: The aim of the study was to assess the average length of a proximal and a distal incision, to verify the location of the axillary nerve and to identify risk factors for nerve injury during minimally invasive plate osteosynthesis. MATERIAL AND METHODS: During cadaver study a total of 24 implantations using the Philos angular stable plate were performed from the minimally invasive anterolateral approach. A five-hole plate inserted with the aid of new Philos aiming device was used in all cases. The plate was fixed with four screws proximally and with three screws to the diaphysis. After implantation either of the incisions were joined and the axillary nerve was exposed on the lateral side of the arm. RESULTS: The nerve was not found to be injured during plate implantation in any of the cases. The average length of the proximal incision was 56 ± 2.8 mm (52-64 mm) and that of the distal incision was 32 ± 2.5 mm (28-35 mm). The middle free part covering the axillary nerve was on average 45 ± 4.3 mm (38-54) long. The average width of the nerve was 1.9 ± 0.35 mm (1.4-2.8 mm). The average distance of the axillary nerve was 39 ± 2.9 mm (37-44 mm) from the superior facet of the greater tubercle and 53 ± 3.9 mm (48-60) from the lower edge of the acromial process. In 80% of the cases the nerve was located in the area determined for the screws going to the medial calcar region; in 20% it was over a hole for the screw directed towards the centre of humeral head. Nerve location above the first six most proximally placed screws was not recorded in any of the cases. DISCUSSION: The minimally invasive anterolateral approach is an alternative technique for osteosynthesis of proximal humerus fractures using angular stable plates. Advantages reported by a number of authors include lower incidence of avascular necrosis of the humeral head, an easier way of reduction and a better view of the rotator cuff. On the other hand, this approach is associated with a higher risk of damage to the axillary nerve. Distance of axillary nerve from acromion is very variable. It may be located in the range of 30 to 85 mm from the acromial edge. CONCLUSION: The anterolateral approach is, when respecting the anatomical position of the axillary nerve, a safe alternative to the conventional deltoideopectoral approach.
- MeSH
- axila inervace MeSH
- fraktury humeru * diagnóza chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- humerus patologie patofyziologie MeSH
- kostní destičky MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky přístrojové vybavení metody MeSH
- peroperační komplikace prevence a kontrola MeSH
- poranění periferního nervu * etiologie prevence a kontrola MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Cieľom práce bolo porovnať výsledok rôzne volenej chirurgickej liečby pri rôznych typoch zlomenín hlavice rádia versus totálna exstirpácia hlavice rádia. Kontrolné vyšetrenie bolo realizo-vané u 42 pacientov 9-12 mesiacov od operačného ošetrenia. Výsledky boli analyzované použitím klasifikácie Wesley et al. [1983]. Najlepšie výsledky boli dosiahnuté pri Mason II type zlomenín, nasledoval typ III a typ IV zlomenín. Po-rovnaním rôznych typov operácií najlepší výsledok bol dosiahnutý pri osteosyntéze skrutkami pri Mason II a III type zlomenín, nasledovala extrakorporálna osteosutúra (hlavica rádia vložená ako spacer). Zlé výsledky boli po totálnej ex-stirpácii hlavice rádia. Menej kominutívna zlomenina hlavice rádia má lepšie operačné výsledky. Osteosyntézu skrutkami treba preferovať, ak je technicky možná. Totálnu exstirpáciu hlavice rádia považujeme za kontraindikovanú.
The purpose of this study was to compare the outcome of various surgical options exercised in the management of different types of radial head fractures versus total exstirpation of radial head. 42 patients were reexamined, with an average follow-up period of 9-12 months after surgical treatment. The results were analysed according to the classification of Wesley et al. [1983]. The best results were obtained in Mason type II fractures, followed by type III and type IV fractures. Com-paring different operations, the best outcome was observed with screw fixation of Mason type II and type III fractures, followed by extracorporal osteosutures (radial head to insert as spacer). Poor results were obtained after exstirpation of the radial head. The less comminution a radial head fracture appears, the better is the outcome. Screw fixation is to be preferred, if technically possible. Total exstirpation of radial head is contraindicated.
- MeSH
- fixace fraktury metody statistika a číselné údaje MeSH
- fraktury vřetenní kosti chirurgie rehabilitace MeSH
- hojení fraktur MeSH
- lidé středního věku MeSH
- lidé MeSH
- ortopedické výkony metody statistika a číselné údaje MeSH
- senioři statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři statistika a číselné údaje MeSH
- ženské pohlaví MeSH
- MeSH
- biotechnologie MeSH
- traumatologie metody MeSH
- Publikační typ
- kongresy MeSH
