Locking plate fixation of three- and four-part proximal humeral fractures

Parmaksizoglu, Atilla Sancar

doi:10.3944/aott.2010.2275

Cited by 26 publications

(18 citation statements)

References 33 publications

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“…The final follow up mean Constant Score was found to be 82.79. The above results are comparable with results in literature, Resch et al [10] , Francesco et al [11] , Fenichel et al [12] , emphasizing the fact that minimally invasive fixation procedure can deliver best results and optimal functional outcome with least damage to soft tissue anatomy. Out of 10 patients treated by Open Reduction and Internal Fixation with anatomical locking plate, 3 (30%) had excellent outcome, 4 (40%) had good outcome, 2 (20%) patients had fair outcome and 1 (10%) had poor outcome.…”

Section: Discussionsupporting

confidence: 82%

Study of outcomes of the proximal humerus fractures treated by various modalities

Soni¹,

Patel²,

Patel³

et al. 2018

Int. J. Orthop. Sci.

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Introduction:The proximal humerus fracture is of great importance when it affects the young and middle age groups of the population as it leads to temporary disability and loss of working hours. Restoration of the function of the limb becomes the primary goal of its treatment. Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply. The present study was conducted to analyze the occurrence, mechanism of injury and displacement of various types of proximal humerus fractures and further evaluate the functional outcome of different modalities of its management. Methods: The following study was conducted at C U Shah Medical College and Hospital, Surendranagar, Gujarat during the period of June 2012 to June 2014. Total 50 patients, 22 males and 28 females with proximal humerus fractures treated with different modalities were selected for the study and assessed by Constant and Murley scoring system with at least 1 year follow up. Results: The average age of patients was 55.6 years out of which 56% were female. Domestic fall was the most common mode of injury (64% patients). Two part surgical neck fractures (Neer's) accounted maximum number of the patients (34%). All One parts and most of the two part fractures treated conservatively. Most of the three part fracture treated with Open reduction and proximal humerus anatomical locking plates. Most common complication was malunion whereas one patient had implant loosening as complication. The average constant score at final follow up for all conservatively treated patients was 75.69, for patients treated by close reduction and percutaneous K wire fixation was 82.79 and for patients treated by open reduction and internal fixation with anatomical locking plate was 73.6. Conclusion: Early Open Reduction and Internal fixation prevents complications like shoulder stiffness, malunion, and late osteoarthritis. Open reduction and rigid internal fixation with proximal humerus plates becomes the choice of treatment for young adults with displaced fractures, whereas fractures in old aged patients with osteoporosis gave good outcome with conservative modality of management. There is also a direct relationship between displaced proximal humerus fractures, fracture severity and eventual results.

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Section: Discussionsupporting

confidence: 82%

Study of outcomes of the proximal humerus fractures treated by various modalities

Soni¹,

Patel²,

Patel³

et al. 2018

Int. J. Orthop. Sci.

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“…Bazı yazarlar standart deltopektoral yaklaşımı tercih ederken [14][15][16][17] diğerleri ise, bu yaklaşımın humerus başının vasküla-rizasyonunda önemli bir role sahip olan anterior sirkumfleks arterin yaralanmasına neden olabileceği gerekçesiyle deltoid split yaklaşımı tavsiye etmektedir. [11,18] Proksimal humerusun 270 derece kontrolüne, kırığın tipine ve yer değiştirmesine göre gerektiğinde tip C kırıklarda artiküler redüksiyonu kolaylaştırmak için döndürücü manşet longitüdinal olarak açılır. Tüberküler fragmanlardan ve döndürücü manşet tendonlarından geçirilen 5 numara Ethibond dikişlerle redüksiyon ve kemik fragmanlarının plağa tespitine olanak sağ-lanır.…”

Section: Discussionunclassified

Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

Korkmaz¹

2015

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Proksimal humerus kırıkları sık görülen ve fonksiyonel kısıtlanmaya neden olan kırıklardandır. Bu geriye dönük çalışmanın amacı aynı fiksasyon metodu kullanılarak deltopektoral ile deltoid split girişimin karşılaştırılmasıdır. GEREÇ VE YÖNTEM: BULGULAR:Lateral deltoid split girişim kullanılan olgularda baş ve tüberküler fragman redüksiyonunun daha iyi olduğu ve Constant omuz skorunun erken dönemde daha yüksek olduğu saptandı (sırasıyla, 66.8-57.4; p<0.01). Aksiller sinir gözlenip askıya alındığı için bu sinire ait komplikasyon saptanmadı. Altıncı aydaki Constant skorları arasında anlamlı farklılık saptanmadı (sırasıyla, 92.2-91.3; p>0.05). SONUÇ:Deltoid split girişim, özellikle AO/ASİF B ve C tipi kırıklarda proksimal humerusun 270 derece kontrolüne, tüberküler parçalardan ve döndürücü manşet tendonlarından geçirilen dikişlerle redüksiyon ve plağa tespitine olanak sağlamaktadır. Deltopektoral girişime göre hastanın iyileşme sürecinde Constant skorları anlamlı olarak farklıdır. Aksiller siniri eksplore ederek yapılan lateral deltoid split girişim, deltoid kas fonksiyonlarını ve aksiller siniri tehlikeye atmadan geniş ve çok yönlü kırık kontrolü sağlayan faydalı bir cerrahi girişim tekniğidir. GİRİŞProksimal humerus kırıkları sık görülen ve üst ekstremitede ciddi fonksiyonel kısıtlanmaya neden olan kırıklardır. Proksimal humerus kırıklarında en yaygın kullanılan cerrahi yaklaşım deltopektoral girişimdir. Plak ile internal fiksasyon sırasında humerusun lateral yüzeyinin net olarak görülmesi gerekebilmektedir. Özellikle atletik hastalarda deltoid ve pektoralis majör kaslarının distal yapışma yerleri deltopektoral yaklaşım ile yapılacak cerrahi girişim esnasında proksimal humerus lateraline ulaşımı kısıtlamaktadır. Proksimal humerus kırıkları-nın tedavisinde kullanılan diğer cerrahi yaklaşım lateral deltoid split girişimdir. [1,2] Deltoid split yaklaşımla humerus başı, tüberculum majus, proksimal humeral şaftın lateral kısmı ve döndürücü manşet direkt görüntülenebilir. Bu yaklaşımın en önemli tehlikesi, aksiller sinirin seyri ve bu sinire ait varyasyonlardan kaynaklanmaktadır.[3] Bu çalışmanın amacı deltopektoral ve deltoid split yaklaşım kullanılarak cerrahi tedavisi yapılan proksimal humerus kırıklı olguların sonuçlarını incelemek ve iki farklı cerrahi yaklaşımın avantaj ve dezavantajlarını karşılaştırmaktır.

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“…Three Part Four Part Our study 8 27 10 Geiger et al, [18] 8 12 4 Erasmo et al, [25] 7 40 35 Parmaksizoglu et al, [19] -12 20 Kumar et al, [20] 8 15 23 Chowdary et al, [23] 22 38 10 Hitesh et al, [27] 10 14 6…”

Section: Neer Fracture Pattern Two Partmentioning

confidence: 99%

“…Geiger et al, [18] Parmarksizoglu et al, [19] Kumar GN et al, [20] Korkmaz et al, [21] Kilic et al, [22] Chowdary et al, [23] Aksu et al, [24] Hitesh et al, [27] Our Study Male 8 10 35 16 13 54 33 7 15 Female 20 22 16 25 9 16 70 23 30 Thus, in our study two thirds of the patients were females, which presents the ratio of 2:1 similar to those studies reported by Parmaksizoglu et al, Aksu et al, Hitesh et al and Geiger et al This confirms our earlier comment that this pattern of fracture occurring in the elderly are more commonly seen in the elderly women, more so about the age of 60 years.…”

Section: Sexmentioning

confidence: 99%

“…31.42% 40% 20% Geiger et al, [18] 39.3% 3.6% 37.1% 20% Erasmo et al, [25] 6.10% 20.73% 63.41% 9.7% Hitesh et al, [27] 3.33% 40% 40% 16.67% Parmaksizoglu et al, [19] 6.3% 25% 28.1% 40.6% Geiger et al, [18] Erasmo et al, [25] Parmaksizoglu et al, [19] Kumar et al, [20] Korkmaz et al, [21] Kilic et al, [22] Chowdary et al, [23] Aksu et al, [24] Our study Due to strict adherence to AO principles and methodological surgical approach, we have been able to keep our complication rates relatively low at 13.33% (n=6) Our complication rates were comparable to the study by Kumar et al, [20] , Korkmaz et al, [21] , Hitesh et al [27] and that of Aksu et al, [24] .…”

Section: Neer Fracture Pattern Two Partmentioning

confidence: 99%

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Proximal humeral internal locking osteosynthesis for surgical fixation for displaced two part to four part fractures: A prospective study

Manek¹,

Venkatachalam²,

Reddy³

2018

Int. J. Orthop. Sci.

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Secure fixation of displaced proximal fractures of the humerus is a challenging problem. Proximal humeral fractures constitute about 5 percent of all upper extremity fractures. They are often considerably displaced and communited in the elderly. About 66 percent of these fractures occur in patient above the age of 60 years. The female to male ratio is about 3:1 and the incidence of this fracture increases with age. It is in these older patients, that the mechanism of injury is usually a low energy trauma. As majority of these fractures occur in the osteoporotic bone, the operative treatment with locking compression plate has of late become the gold standard. The aim of the present study is to analyse prospectively, 45 cases of proximal humeral peri-articular fractures, occurring in the osteoporotic bone of the elderly, in the age group of 50 to 69 years treated surgically with PHILOS plating. It is to study their radiological and functional outcome score so the clinical outcomes and then to compare it with published literature. Also, comparison shall be made as to the time elapsed from injury to surgery, the surgery duration, the loss of blood during surgery, post-op complications and the time required for radiological bony union. In our series, the clinical outcome assessed as per the Constant Shoulder Score, achieved 44.45% fair, 40% good and 11.11% excellent results. We had 4.44% of poor outcomes. Our study conclusively shows that LCP should be considered as a gold standard in treating displaced peri-articular proximal humeral fractures especially in the elderly with osteoporotic bone. These implants provide greater angular stability, better biomechanical properties and enhanced anchorage in these complex injuries. The goal of the treatment is primarily to restore a painless shoulder with reasonably satisfactory function.

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Locking plate fixation of three- and four-part proximal humeral fractures

Cited by 26 publications

References 33 publications

Study of outcomes of the proximal humerus fractures treated by various modalities

Study of outcomes of the proximal humerus fractures treated by various modalities

Comparison of lateral deltoid splitting and deltopectoral approaches in the treatment of proximal humerus fractures

Proximal humeral internal locking osteosynthesis for surgical fixation for displaced two part to four part fractures: A prospective study

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