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Helical plating of the proximal humerus
Michael J Gardner1, Matthew H Griffith, Dean G Lorich
1Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. gardnerm@hss.edu
Injury
|September 1, 2005
Summary
Helical plating offers a minimally invasive option for proximal humerus fractures. Surgeons can safely place screws percutaneously by avoiding the musculocutaneous nerve's path.
Area of Science:
- Orthopedic Surgery
- Surgical Anatomy
Background:
- Optimal treatment for proximal humerus fractures remains debated.
- Helical plating is an emerging technique for these fractures.
Purpose of the Study:
- To assess the feasibility of minimally invasive helical plating.
- To identify risks associated with percutaneous screw placement in helical plating.
Main Methods:
- Cadaveric dissection of 10 upper extremity specimens.
- Extended anterolateral acromial approach for helical plating.
- Percutaneous screw placement and identification of neurovascular structures.
Main Results:
- The musculocutaneous nerve was the only structure at risk.
- A consistent "danger zone" for the nerve was identified.
- The average danger zone was 13.5 cm from the greater tuberosity.
Conclusions:
- Minimally invasive helical plating is feasible.
- Avoiding the identified danger zone ensures safe percutaneous screw placement.
- Further clinical validation of this technique is warranted.