Internal fixation of proximal humeral fractures with a locking compression plateA retrospective evaluation of 72 patients followed for a minimum of 1 year

Björkenheim, Jan-Magnus; Pajarinen, Jukka; Savolainen, Vesa

doi:10.1080/00016470410004120

Cited by 290 publications

(252 citation statements)

References 12 publications

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“…As mentioned, maybe in a larger collective of patients, significant differences could be revealed. The overall rate for complications after internal fixation of proximal humeral head fractures is documented in the actual literature as between 10% and 34% [1,2,7,8,11,13,17,19,20,22]. The small rate of complications in our study (14% deltoid split; 13% deltopectoral) may be explained by the fact that three experienced surgeons performed the osteosynthesis.…”

Section: Discussionmentioning

confidence: 50%

“…The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Questions/purposes In this prospective randomized study, we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to (1) complication rate; (2) shoulder function (Constant score); and (3) pain (visual analog scale [VAS]) for internal fixation of displaced humeral fractures with a polyaxial locking plate.…”

Section: Introductionmentioning

confidence: 99%

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Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Questions/purposes In this prospective randomized study, we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to (1) complication rate; (2) shoulder function (Constant score); and (3) pain (visual analog scale [VAS]) for internal fixation of displaced humeral fractures with a polyaxial locking plate.Methods We randomized 120 patients with proximal humeral fractures to receive one of these two approaches (60 patients for each approach). We prospectively documented demographic and perioperative data (sex, age, fracture type, hospital stay, operation time, and fluoroscopy time) as well as complications. Followup examinations were conducted at 6 weeks, 6 months, and 12 months postoperatively, including radiological and clinical evaluations (Constant score, activities of daily living, and pain [VAS]). Baseline and perioperative data were comparable for both approaches. The sample size was chosen to provide 80% power, but it reached only 68% as a result of the loss of followups to detect a 10-point difference on the Constant score, which we considered the minimum clinically important difference. Results Complications or reoperations between the approaches were not different. Eight patients in the deltoid-split group (14%) needed surgical revisions compared with seven patients in the deltopectoral group (13%; p = 1.00). Deltoid-split and deltopectoral approaches showed similar Constant scores 12 months postoperatively (Deltoid-split 81; 95% confidence interval [CI], 74-87 versus deltopectoral 73; 95% CI, 64-81; p = 0.13), and there were no differences between the groups in terms of pain at 1 year (deltoid-split 1.8; 95% CI, 1.2-1.4 versus deltopectoral 2.5; 95% CI, 1.7-3.2; p = 0.14). No learning-curve effects were noted; fluoroscopy use during surgery and function and pain scores during followups were similar among the first 30 patients and the next 30 patients treated in each group. Conclusions The treatment of proximal humeral fractures with a polyaxial locking plate is reliable using both approaches. For a definitive recommendation for one of these approaches, further studies with appropriate sample size are necessary.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Inclusion criteria included all patients 18 years of age or older with a displaced fracture or fracture-dislocation of the proximal humerus as defined by previously defined criteria [2,5,8,13,14,25,26]. We excluded patients with preexisting nerve deficits before their current proximal humerus fracture.…”

Section: Methodsmentioning

confidence: 99%

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

Warrender

Oppenheimer

Abboud

2011

Clinical Orthopaedics &Amp; Related Research

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Background The incidence of neurologic injury after proximal humerus fractures is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring. Questions/purposes Therefore, using intraoperative nerve monitoring, we assessed the incidence, pattern of nerve involvement, and predisposing factors for nerve injury before and during shoulder fracture fixation. Patients and Methods We used continuous intraoperative monitoring of the brachial plexus in 37 patients undergoing open operative treatment of proximal humerus fractures. Impending intraoperative compromise of nerve function was signaled by sustained neurotonic EMG activity or greater than 50% amplitude attenuation of transcranial electrical motor evoked potentials (MEPs) (or both). When a nerve alert occurred, current surgical activity and arm and retractor position were recorded and adjustments were made to relieve tension.

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“…Because the results of humeral head replacement for proximal humeral fractures have been so unpredictable, it is critical that the results of osteosynthesis for these fractures be improved. Previous reports of locking plates used for proximal humeral fractures cite overall complications rates between 10% and 34% [2,7,8,13,15,16]. Research initiatives must focus on lowering these complication rates.…”

Section: How Do We Get There?mentioning

confidence: 99%

CORR Insights®: Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Duralde

2014

Clinical Orthopaedics &Amp; Related Research

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Internal fixation of proximal humeral fractures with a locking compression plateA retrospective evaluation of 72 patients followed for a minimum of 1 year

Cited by 290 publications

References 12 publications

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Nerve Monitoring During Proximal Humeral Fracture Fixation: What Have We Learned?

CORR Insights®: Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

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