Displacement/Screw Cutout After Open Reduction and Locked Plate Fixation of Humeral Fractures

Owsley, Kevin C.; Gorczyca, John T.

doi:10.2106/jbjs.f.01351

Cited by 435 publications

(356 citation statements)

References 21 publications

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“…8 The goal of surgery is obtaining and maintaining satisfactory reduction in order to allow early motion, achieve healing and restore function. 1 Several authors have presented short term results with mixed outcome. 2 Frankhauser et al reviewed their experience of 28 patients with 29 proximal humerus fractures treated with locking proximal humeral plate.…”

Section: Discussionmentioning

confidence: 99%

“…1 Their overall incidence has been reported to be 73 cases per 100, 000 individuals per year. 2 As indicated by Cofield , areas still in question include radiographic diagnosis, operative or non operative treatment, consideration of patient age in treatment decision making, surgical approach, fracture fixation or hemiarthroplasty, type of internal fixation, and rehabilitation protocol.…”

Section: Introductionmentioning

confidence: 99%

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Outcome analysis of patients with proximal humerus fractures treated with locking plates

et al. 2017

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INTRODUCTIONFractures of proximal humerus represent no more than 3% of all upper extremity fractures.1 Their overall incidence has been reported to be 73 cases per 100, 000 individuals per year. 2 As indicated by Cofield , areas still in question include radiographic diagnosis, operative or non operative treatment, consideration of patient age in treatment decision making, surgical approach, fracture fixation or hemiarthroplasty, type of internal fixation, and rehabilitation protocol. About 85% fractures are minimally displaced and are effectively treated symptomatically with immobilization followed by early motion. The remaining 15% of fractures are displaced, unstable and may have disruption of blood supply. Treatment of these fractures is a therapeutic challenge. ABSTRACTBackground: Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure. Methods: This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them. Results: Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome. Conclusions: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome analysis of patients with proximal humerus fractures treated with locking plates

et al. 2017

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“…Owsley et al reported a significant increase of complication rate in their elderly patients. 23 In addition, a multicenter trial found a relative risk increase of 3.3 of implant-related complications in the their elderly population, and the number of postoperative complication was directly corollary with functional outcome. 7 Our study does contain a number of limitations, most notably its small sample size and retrospective nature.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

Grawe

Lee

et al. 2011

Geriatr Orthop Surg Rehabil

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Introduction: Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3-and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. Methods: A retrospective review was completed to identify patients whom had sustained a 3-or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3-vs 4-part) and patient age at time of fracture (<65 years vs >65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Results: Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the score for those older than 65 was 12.5. Neither the Constant score nor the DASH score differed in a statistically significant manner, when comparing patients who were younger than 65 to those older than 65 years of age. Conclusion: The current series of fractures was able to demonstrate similar and satisfactory outcomes following locked plating treatment of complex 3-and 4-part proximal humerus fractures in younger patients and patients older than the age of 65, while still accepting the null hypothesis.

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“…Second, the decision to indicate patients for surgery and to use the locking plate was at the discretion of the treating surgeon, as were the number of screws used in the humeral head, which may have potentially affected our complication rate. Other investigators have noted the number of screws in the head may influence cutout, fixation, fracture healing, or perfusion of the humeral head [21]. We only analyzed patients who underwent surgical treatment with a locking plate and did not include patients who underwent arthroplasty or other fixation methods.…”

Section: Discussionmentioning

confidence: 99%

“…Intra-articular screw perforation was our most prevalent complication, and it can arise because of improper hardware placement due to poor intraoperative imaging, screw migration/ implant shifting, or collapse of the subchondral bone onto the stationary hardware [9]. The incidence of this complication is well documented in the current literature and ranges from 5% to 23% [8,9,14,18,21]. This complication can cause substantial injury to the glenohumeral joint, require reoperation, and lead to permanent loss of joint function [29].…”

Section: Discussionmentioning

confidence: 99%

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Ong

Bechtel

Walsh

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Locking plates have become a commonly used fixation device in the operative treatment of three-and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures. Questions/purposes We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three-and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates. Patients and Methods We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period.

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Displacement/Screw Cutout After Open Reduction and Locked Plate Fixation of Humeral Fractures

Cited by 435 publications

References 21 publications

Outcome analysis of patients with proximal humerus fractures treated with locking plates

Outcome analysis of patients with proximal humerus fractures treated with locking plates

Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

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