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Beitragstitel Minimally invasive lateral plating for metadiaphyseal fractures of the humerus and its implications for the deltoid muscle: functional analysis and MR-imaging
Beitragscode P68
Autoren
  1. Dea Flury Zuger Kantonsspital Vortragender
  2. Christoph Metzler
  3. Simon Rauch
  4. Michel Schläppi Kantonsspital Winterthur
  5. Emanuel Benninger Kantonsspital Winterthur (KSW)
  6. Christoph Meier Kantonssiptal Winterthur (KSW)
Präsentationsform Poster
Themengebiete
  • A08 - Grundlagenforschung
Abstract Introduction
Minimally invasive lateral plate osteosynthesis of the humerus (MILPOH) is an alternative to other minimally invasive fixation options of the humeral shaft such as anterior plating, the use of helical plates or intramedullary nailing. The plate is introduced through a deltoid split proximally and advanced through the middle portions of the deltoid insertion and between bone and brachial muscle to the distal aspect of the humerus. It was the aim of this study to evaluate the implications of this manoeuvre on the integrity of the deltoid insertion and muscle function as this have never been studied before.

Methods
Informed consent was obtained from 7 patients (median age 60 years, range 51-73 years, f/m 6/1) who had undergone MILPOH between 08/2017 and 08/2020. Functional testing was performed for the injured and uninjured extremity including strength measurements for 30/60/90° shoulder abduction. CMS, DASH, Oxford Shoulder Score (OSS) and EQ-5D were obtained. MR imaging was performed for both shoulders accordingly to assess the integrity of the distal insertion, muscle mass and fatty degeneration of the deltoid muscle.

Results
Median follow-up was 30 months (range 12-46 months). The difference in median abduction force according to MILPOH compared to the uninjured side was between - 9 % (30°) and 27 % (90°). Age- and gender-adapted CMS was 88 (79-99) compared to 98 (92-110), median OSS was 42, ranging from 37-48. DASH was 26 (15-36). VAS-EQ-5D of the affected extremity ranged from 81-95 with a median of 90. EQ-5D index was 1 (1-1). Deltoid muscle mass showed a heterogeneous pattern with a median difference of 1.4% and a wide range from -21% to 35% compared to the uninjured side. Neither a relevant fatty infiltration of the deltoid muscle nor an inconsistency of the deltoid insertion was observed.

Conclusions
MILPOH is associated with good functional and subjective outcome despite a slight reduction of abduction strength. Neither muscle mass nor muscle quality correlated with functional outcome. MILPOH does not appear to affect the structural quality of the deltoid muscle and the integrity of its attachment remains intact.