• Yves P Acklin, Raphael Jenni, Martin Walliser, and Christoph Sommer.
• General Surgery, Trauma Unit, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland. yvespascal.acklin@ksgr.ch.
• Eur J Trauma Emerg S. 2009 Feb 1;35(1):35-9.

IntroductionThe anterior delto-pectoral approach is the standard approach for the fixation of proximal humeral fractures with the PHILOS(®)-Plate system. However, this approach can impair the vascular supply and can increase avascular necrosis. The objective of this study was to evaluate the results and complexity of surgery of proximal humeral fractures with a minimal invasive (MIPO) approach.MethodsAll PHILOS(®)-plate osteosynthesis operated between Januray 2003 and June 2006 were evaluated prospectively. A minimal invasive antero-lateral deltasplit-approach was performed in all two to four fragment instable fractures meeting the indication for osteosynthesis according to Neer. An open approach (ORIF) was chosen in all other fractures mainly dislocated fractures and particularly in fractures with major subcapital displacement.ResultsA cohort of 68 patients suffered a proximal humerus fracture and qualified for a minimal invasive approach with a PHILOS(®)-plate osteosynthesis. Of these 68 patients, 41 were locally resident. Eight patients refused a follow-up, two patients were in constant care, and two patients died; 29 patients (71%) (20 females, 9 males) could be documented entirely with a median age of 64 years. The median operation time amounted to 75 min with a fluoroscopic time of 160 s. The median Constant score was 78 after 12 months. All fractures healed in adequate time. One patient showed a lesion of the ventral part of the axillary nerve. No patient suffered an avascular necrosis.DiscussionThe minimal invasive PHILOS(®) plate osteosynthesis through an antero-lateral delta-split approach proved to be an elegant procedure for selected fractures of the proximal humerus with a low morbidity and good functional outcome.

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