A Novel approach: Combined use of medial anatomical locking
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The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. Authors present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column.

An anatomical study was performed and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12?months postoperatively.

Results:
-There was a safe region located at the medial part of the proximal humerus just beneath the articular surface.
-An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint.
-Successful fracture healing was achieved in all 8 cases.
-The function and range of motion of the shoulder joint were satisfactory 24?months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (more than?10° in any direction), screw cutout, nonunion, or deep infection occurred.

Conclusively, the combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-02094-7
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