The results of ORIF of displaced unstable proximal humeral fractures using a locking plate

Duralde, Xavier A.; Leddy, Lee R.

doi:10.1016/j.jse.2009.08.008

Cited by 60 publications

(56 citation statements)

References 33 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%

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%

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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“…Since 2006, nine case series have been reported in ten publications [13,19,42,43,45]. One series was reported on twice [28,50].…”

Section: Resultsmentioning

confidence: 99%

Evidence for Success with Locking Plates for Fragility Fractures

Cornell

Ayalon

2011

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.

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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%

“…Osteoporosis often limits the success of devices to gain fixation in the proximal fragment in this region. Although there are a myriad of fixation devices available, recent studies have demonstrated good results with locking plates [1,7,9,14], locking rods [17], various percutaneous pin techniques [10,12], and even suture fixation [6]. The variety of hardware options and techniques suggests there is no single best approach for many proximal humerus fractures, and that we still have much to learn about how to manage patients with these injuries.…”

mentioning

confidence: 99%

The results of ORIF of displaced unstable proximal humeral fractures using a locking plate

Cited by 60 publications

References 33 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?

Evidence for Success with Locking Plates for Fragility Fractures

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

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