{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:21:38Z","timestamp":1791339698971,"version":"4.3.1"},"reference-count":26,"publisher":"Bentham Science Publishers Ltd.","issue":"1","license":[{"start":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T00:00:00Z","timestamp":1308268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["openorthopaedicsjournal.com","benthamopen.com"],"crossmark-restriction":true},"short-container-title":["TOORTHJ"],"published-print":{"date-parts":[[2011,6,17]]},"abstract":"<jats:p>The minimal anterolateral acromial approach offers a less invasive access to the proximal humerus. Functional impairment following this procedure may be caused by paresis of the deltoid muscle as a result of iatrogenic injury to the axillary nerve. It was addressed whether electromyography (EMG) of the deltoid muscle gives evidence for an axillary nerve lesion in association with the minimal anterolateral acromial approach.<\/jats:p>\n                  <jats:p>Twenty-three patients (14 men, 9 women; average age 58 years) with proximal humerus fractures were included in this clinical observation. Follow-up was performed 6 weeks (6w), 6 months (6m) and 12 months (12m) postoperatively. EMG changes indicating either lesion of the axillary nerve or direct muscle trauma were distinguished in \u201cacute\u201d, \u201cchronic\u201d and \u201ccombined\u201d and semi quantified in \u201cslight\u201d, \u201cmoderate\u201d and \u201csevere\u201d. Patients were examined clinically (standard neurological examination and Constant Score).<\/jats:p>\n                  <jats:p>Three cases of incomplete axillary nerve lesion with limited functional impairment were detected. Subclinical EMG signs of neural impairment of the deltoid muscle were observed frequently (6w, N = 8; 6m, N = 8; 12m, N = 7). Functional outcome did not show an association with EMG.<\/jats:p>\n                  <jats:p>Most patients presented with subclinical and most likely trauma- related neurogenic lesions of the deltoid muscle following the anterolateral acromial approach. Despite the fact that the axillary nerve does not function normally following this less-invasive approach for fixation of proximal humerus fractures, this does not appear to affect the clinical outcome. Prospective studies with larger sample sizes are required to determine the effect of axillary nerve retraction in the more commonly used deltopectoral approach.<\/jats:p>","DOI":"10.2174\/1874325001105010223","type":"journal-article","created":{"date-parts":[[2011,6,24]],"date-time":"2011-06-24T03:07:04Z","timestamp":1308884824000},"page":"223-228","update-policy":"https:\/\/doi.org\/10.2174\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Electrophysiological Assessment of the Deltoid Muscle after Minimally Invasive Treatment of Proximal Humerus Fractures - A Clinical Observation"],"prefix":"10.2174","volume":"5","author":[{"given":"G\u00f6tz","family":"R\u00f6derer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Dorte","family":"Sperfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert","family":"Krischak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Gebhard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Kassubek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"965","reference":[{"key":"refR1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00003086-199307000-00005","volume":"292","author":"Szyszkowitz R","year":"1993","unstructured":"Szyszkowitz R, Seggl W, Schleifer P, Cundy PJ. \n                    Proximal humeral fractures: management techniques and expected results \n                    Clin Orthop Relat Res  \n                    1993; \n                    292\n                    : 13-25.","journal-title":"Clin Orthop Relat Res"},{"key":"refR2","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.2106\/00004623-200211000-00002","volume":"84-A","author":"Wijgman AJ","year":"2002","unstructured":"Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. \n                    Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus \n                    J Bone Joint Surg Am  \n                    2002; \n                    84-A\n                    : 1919-25.","journal-title":"J Bone Joint Surg Am"},{"key":"refR3","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/01.bot.0000246412.10176.14","volume":"20","author":"Gardner MJ","year":"2006","unstructured":"Gardner MJ, Voos JE, Wanich T, Helfet DL, Lorich DG. \n                    Vascular implications of minimally invasive plating of proximal humerus fractures \n                    J Orthop Trauma  \n                    2006; \n                    20\n                    : 602-7.","journal-title":"J Orthop Trauma"},{"key":"refR4","doi-asserted-by":"crossref","first-page":"SA25","DOI":"10.1016\/S0020-1383(01)00058-4","volume":"32","author":"Resch H","year":"2001","unstructured":"Resch H, Hubner C, Schwaiger R. \n                    Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head \n                    Injury  \n                    2001; \n                    32\n                    (Suppl 1)\n                    : SA25-32.","journal-title":"Injury"},{"key":"refR5","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00113-006-1227-x","volume":"110","author":"R\u00f6derer G","year":"2007","unstructured":"R\u00f6derer G, Gebhard F, Erhardt J, et al. \n                    The Non-Contact Bridging Plate. 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A prospective clinical and EMG study \n                    J Bone Joint Surg Br  \n                    1994; \n                    76\n                    : 381-.","journal-title":"J Bone Joint Surg Br"},{"key":"refR22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/S0303-8467(99)00011-6","volume":"101","author":"Visser CP","year":"1999","unstructured":"Visser CP, Tavy DL, Coene LN, Brand R. \n                    Electromyographic findings in shoulder dislocations and fractures of the proximal humerus: comparison with clinical neurological examination \n                    Clin Neurol Neurosurg  \n                    1999; \n                    101\n                    : 86-91.","journal-title":"Clin Neurol Neurosurg"},{"key":"refR23","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/00003086-198701000-00023","volume":"214","author":"Constant CR","year":"1987","unstructured":"Constant CR, Murley AH. \n                    A clinical method of functional assessment of the shoulder \n                    Clin Orthop Relat Res  \n                    1987; \n                    214\n                    : 160-4.","journal-title":"Clin Orthop Relat Res"},{"key":"refR24","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.2106\/JBJS.H.00006","volume":"91","author":"Sudkamp N","year":"2009","unstructured":"Sudkamp N, Bayer J, Hepp P, et al. \n                    Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. 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