The plate fixation strategy of complex proximal humeral fractures

Abstract

Purpose For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate fixation is still a preference and the proper selection of its strategy for each individual seems to be essential. Method The available classification system of the fracture, determination of surgical intervention, the common complications and related causes, and the latest critical surgical strategies with locking plate fixation were discussed in this review. Results The frequent complications with complex proximal humeral fractures after operative treatment present a great challenge to orthopedic surgeons. In order to maintain the stability of locking plate fixation, several options including calcar screw, bone graft, bone cement augmentation, dual plate fixation, and fracture impaction were available for restoration of medial support. Conclusion Restoration of medial support seems of importance to provide solid stability and reduced complication for the complex fractures with fixation of locking plates.

Comparison of Spiral Versus Lateral Plate Fixations in Treatment of Multiple Humeral Fractures: A Finite Element Analysis

“…The maximum equivalent stress distribution of the internal fixation is an important criterion to measure the quality of the internal fixation. The internal fixation should have a uniform stress distribution and a small maximum equivalent stress value [2]. Under the three working conditions, the maximum Von Mises stress on the internal fixation is mainly distributed near the broken end of the fracture.…”

“…Humeral fractures often occurs in ball games, such as throwing or arm-wrestling movement, can also be found in a car accident injury, machine and scratches. Currently, the clinical treatment of middle and proximal humeral fractures is conventionally performed by interlocking intramedullary nail or locking plate percutaneous internal fixation [2][3]. Although some scholars think that these fractures can be treated without surgery [4], a recent study, involving a randomized controlled trial, concluded that surgical plating has a statistically significant advantage with a greater function, more rapid bone union, and lower deformity rate [5].…”

Different treatments for 3- or 4-part proximal humeral fractures in the elderly patients: A Bayesian network meta-analysis of randomized controlled trials

“…We reanalyzed the included literature by excluding each piece one at a time, and after excluding Fraser's (21) literature, we discovered that the reoperation rate SUCRA values for LP were significantly higher than HA. This finding may be related to the fact that, despite being consistently categorized as locking plate internal fixation, the technique of the procedure and the plates have been evolving over time (32)(33)(34). This implies that the results of earlier human research need to be viewed with greater objectivity because improved surgical procedures and plates may have reduced the incidence of negative events like reoperation rates for LP-treated proximal humeral fractures.…”

Comparison of “Bilboquet” device and locking plate for surgical treatment of proximal humerus complex fractures at two years follow-up

“…Most publications on locking plates insist on the difficulty of achieving stable fixation in the event of severe displacement and comminuted fragments [17]. Large, prospective, multicentre trials by Südkamp et al [18] and Brunner et al [19] showed that internal fixation with locking plate was associated with good functional outcome but with a high percentage of implant-related complications (particularly primary and secondary screw perforation).…”