Humerus, proximal: intraarticular bilateral fracture (right side: four-part varus displaced fracture 11-C2, left side: four-part valgus displaced fracture 11-C2)
Case description
A 60-year-old man sustained bilateral fractures of the proximal humerus and mild traumatic brain injury (contusion cerebri) following a ski accident.
Indication for MIPO
Unstable and particularly bilateral fractures of the proximal humerus are well-accepted indications for operative stabilization. Postoperative early motion of the shoulder joint minimizes residual adhesions and stiffness. Angle-stable implants have shown good fracture fixation.
The MIPO technique (anterolateral deltoid-split approach) for proximal humeral fractures allows easy access to the plating zone on the lateral aspect of the humerus. The applied retraction forces and possible intraoperative displacement of the fracture zone as experienced in the deltoid-pectoral approach is nonexistent.
The MIPO approach can endanger the axillary nerve if the incision is extended more than 5 cm distal to the acromion.
Preoperative planning
The fracture pattern must be considered for fixation. Normally the humeral head is dislocated dorsally. For easy MIPO fracture treatment, a valgus type displacement is much simpler to stabilize than a varus type. The initial closed conversion of a varus displacement into a valgus displacement is recommended. In this case the screw insertion was identical for left and right sides. After the reduction of the fractures the 5-hole PHILOS plate is inserted after the plate position is verified with image intensifier. The LHS (1) is first inserted into the humeral head. The last distal hole is fixed with a cortex screw (2). The sequence of screws is indicated in Fig 12.5-2 .
Operating room setup
Anesthesia
A general anesthesia is preferred.
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