Angular Stable Fixation of Proximal Humeral Fractures

Abstract

With regards to fracture healing and functional outcome of the patients, we had a satisfactory outcome after angular stable plate fixation of proximal humeral fractures. However, we experienced a notably high rate of technical failures and partial humeral head necrosis. Advanced surgical skills and experiences are necessary to achieve correct anatomic reduction and implant fixation, to reduce the risk of these treatment-related complications.

Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

“…One year postoperatively, the mean Constant and Murley score of the injured side for our patients was 72 points corresponding to 87% of the score on the contralateral side. In some other studies, the mean Constant and Murley scores after angular stable plate or angular stable nail fixation of proximal humeral fractures ranged between 72 and 89 points [12,17,21,28,30], which also are comparable to our results. Nevertheless, most of these published studies do not distinguish between different fracture types.…”

“…The management of these fractures may be challenging owing to displacement by the rotator cuff, devascularization of the humeral head, and osteoporosis. Treatment options of displaced and unstable proximal humeral fractures vary widely, implying a lack of consensus regarding optimal management of these injuries [14,30,31]. The goals of surgery are to obtain anatomic fracture reduction and stable primary fixation to ensure rapid fracture healing and immediate postoperative functional therapy without prolonged immobilization [11,12].…”

Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures—results of an international multicentre study

“…While non-displaced fractures can be treated nonoperatively, surgical treatment is recommended for displaced fractures and commonly involves open reduction and internal plate fixation. Clinically relevant complications such as loss of reduction, screw loosening, and osteonecrosis of the humeral head are frequently observed after surgery, especially in association with poor bone quality [3][4][5][6]. In order to reduce the complication rate, anatomically shaped locking plates have been developed (proximal humeral Internal locking system [PHILOS] and locking proximal humeral plate [LPHP]; Synthes GmbH, Switzerland).…”

Functional outcome and incidence of avascular necrosis after two years in four part proximal humeral fractures treated by proximal humerus internal locking system

“…Evaluation of results at 6 months was done on the basis of scoring system given by Constant et al Results were graded as Excellent (80%-100%), Good (60%-79%), Fair (40%-59%) or Poor (0-39%). Constant and Murley score, the most commonly used method of shoulder functional assessment, consists of 100 points allotted to pain (15), activities of daily living (20), range of motion (40) and power (25). Wound infections were seen in 3 patients (superficial in 2 patients and deep in one), impingement and adhesive capsulitis was identified in 4 patients (7.6 %) each.…”