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Randomized Controlled Trial
. 2017 May 12;18(1):187.
doi: 10.1186/s12891-017-1538-9.

Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures

Li Zhao  1 , Peng Yang  1 , Lei Zhu  1 , Ai-Min Chen  2
Affiliations
Randomized Controlled Trial

Minimal invasive percutaneous plate osteosynthesis (MIPPO) through deltoid-pectoralis approach for the treatment of elderly proximal humeral fractures

Li Zhao et al. BMC Musculoskelet Disord. .

Abstract

Background: Current treatments for proximal humeral fractures include conservative treatment, conventional open reduction internal fixation (ORIF) and MIPPO through deltoid-splitting approach. The aim of this study was to evaluate the clinical outcome of MIPPO versus ORIF via the deltoid-pectoralis approach in elderly patients with proximal humeral fractures.

Methods: Thirty-six patients with proximal humeral fractures were enrolled in this study. Following the randomized block and single-blinded principle, the patients were assigned to two groups and treated with either conventional ORIF or MIPPO, both through the deltoid-pectoralis approach. Surgical outcomes were evaluated by the NEER score, Constant-Murley score, blood loss, length of operation, radiological imaging and clinical examination. The patients were followed up for 4-24 (mean 10) months.

Results: According to Constant-Murley score, the surgical outcome was excellent in 14 cases, satisfactory in 2 cases and unsatisfactory in one case in MIPPO group versus 10, 5 and 4 in conventional ORIF group. MIPPO was significantly advantageous over conventional ORIF in terms of NEER score, Constant-Murley, length of operation and intraoperative blood loss. In addition, MIPPO was also more advantageous in several indexes in patients with BMI > 26.0 and NEER type III fracture.

Conclusion: The results of our study have demonstrated that MIPPO through the deltoid-pectoralis approach is an effective alternative for the treatment of proximal humeral fractures in elderly patients.

Trial registration: The trial registration number (TRN): ChiCTR-INR-17011098 (retrospectively registered at 2017-04-09).

Keywords: Deltoid-pectoralis approach; Minimal invasive percutaneous plate osteosynthesis (MIPPO); Proximal humeral fractures.

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Figures

Fig. 1
Fig. 1
Follow-up data of a 66-year-old female. a Pre-operative X-ray shows an unstable right proximal humeral fracture. b intraoperative incisions (a 5-6 cm incision and a 1 cm incision). c/d Post-operative X-rays in in anteroposterior and lateral views show a good reduction and proper placement of the plate
Fig. 2
Fig. 2
At the 6-month follow-up, the patient had a good shoulder function. The 6-month constant score was 90
See this image and copyright information in PMC

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