Functional follow-up of locking plate fixation of fractures of the proximal humerus

Abstract Background and hypothesis The typical anterolateral approach is widely used to treat proximal humerus fractures with lateral locking fixation. However, lateral fixation cannot completely avoid medial reduction loss and varus deformity especially in the cases of an unstable medial column. We present a novel medial surgical approach and technique together with a minimally invasive lateral locking plate to fix proximal humerus fractures with an unstable medial column. Materials and methods We performed an anatomical study and reported 8 cases of proximal humerus fractures with unstable medial columns treated with plate fixation through a minimally invasive anterolateral approach and medial approach. All surgeries were performed by the same single surgeon. Patients were followed clinically and radiographically at 1, 3, 6, and 12 months postoperatively. Results There was a safe region located at the medial part of the proximal humerus just beneath the articular surface. An anatomical medial locking proximal humerus plate could be placed in the medial column and did not affect the axillary nerve, blood supply of the humeral head, or stability of the shoulder joint. Successful fracture healing was achieved in all 8 cases. The function and range of motion of the shoulder joint were satisfactory 24 months postoperatively, with an average Constant score (CS) of 82.8. No reduction loss (≥ 10° in any direction), screw cutout, nonunion, or deep infection occurred. Conclusions The combined application of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation is effective in maintaining operative reduction and preventing varus collapse and implant failure in proximal humerus fractures with an unstable medial column.

Download Full-text

A systematic review of locking plate fixation of proximal humerus fractures

Injury ◽

10.1016/j.injury.2010.11.058 ◽

2011 ◽

Vol 42 (4) ◽

pp. 408-413 ◽

Cited By ~ 223

Author(s):

Robert C. Sproul ◽

Jaicharan J. Iyengar ◽

Zlatko Devcic ◽

Brian T. Feeley

Keyword(s):

Systematic Review ◽

Locking Plate ◽

Proximal Humerus ◽

Plate Fixation ◽

Proximal Humerus Fractures ◽

Locking Plate Fixation ◽

Humerus Fractures

Download Full-text

Computational optimisation of screw orientations for improved locking plate fixation of proximal humerus fractures

Journal of Orthopaedic Translation ◽

10.1016/j.jot.2020.02.007 ◽

2020 ◽

Vol 25 ◽

pp. 96-104 ◽

Cited By ~ 2

Author(s):

Dominic Mischler ◽

Markus Windolf ◽

Boyko Gueorguiev ◽

Stefaan Nijs ◽

Peter Varga

Keyword(s):

Locking Plate ◽

Proximal Humerus ◽

Plate Fixation ◽

Proximal Humerus Fractures ◽

Locking Plate Fixation ◽

Humerus Fractures

Download Full-text

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: a retrospective study

10.21203/rs.3.rs-33348/v1 ◽

2020 ◽

Author(s):

Shengkun Hong ◽

Wei Wang ◽

Jinku Guo ◽

Feixiong He ◽

Cong Wang

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Clavicle Fracture ◽

Operation Time ◽

Locking Plate Fixation ◽

Traditional Methods ◽

Traditional Group ◽

Lag Screw ◽

Clavicle Fractures

Abstract Background: Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are two main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots versus traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.Methods: We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing and complications were assessed at a follow-up of 12 to 40 months.Results: The mean age of all the patients was 50.8 years. There were 52 and 49 patients in Nice knot group and traditional group respectively, and no differences between two groups was found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (p < 0.01) than the traditional group (mean and standard deviation [SD], 78.6±19.0 compared with 94.4±29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there was no significant differences between groups, despite the Nice knot group had slightly better results.Conclusions: Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

Download Full-text

Outcomes of Proximal Femoral Locking-plate Fixation for Pathological Fractures of the Proximal Femur

Siriraj Medical Journal ◽

10.33192/smj.2021.78 ◽

2021 ◽

Vol 73 (9) ◽

pp. 603-608

Author(s):

Kongkhet Riansuwan ◽

Somkiat Jivasomboonkul ◽

Rapin Phimolsarnti ◽

Chandhanarat Chandhanayingyong ◽

Apichat Asavamongkolkul

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Plate Fixation ◽

Clinical Results ◽

Assistive Device ◽

Locking Plate Fixation ◽

Pathological Fractures ◽

Hardware Failure ◽

Estimated Blood Loss

Objective: To study the treatment outcomes of proximal femoral locking-plate fixation of pathological fractures ofthe proximal femur relative to clinical results, implant failure, and surgical complications.Materials and Methods: From 2007 to 2018, 17 patients (18 femurs) with a diagnosis of impending or existingpathological fracture of the proximal femur were treated with proximal femoral locking-plate fixation. Data collectedincluded operative duration, estimated blood loss, ambulatory status, hardware failure events, and postoperativecomplications.Results: Of the 18 femurs that were included, 13 were existing pathological fractures and 5 were impending fractures.The mean age of patients was 53.7 years (range: 28-89), and 12 of them were female. The mean follow-up was 11.3months (range: 1-67). Ten of 17 patients (62.5%) had progressive lung disease from pulmonary metastasis or fromlung primary. No patient developed oxygen desaturation or cardiac arrest during the intraoperative or postoperativeperiod. Thirteen of 17 patients (76.5%) could walk with or without an assistive device at the time of final follow-up.Two patients required close postoperative monitoring in the intensive care unit due to poor preoperative status,and both of those patients died within one month after surgery from other medical problems. No hardware failureoccurred.Conclusion: For pathological fracture of the proximal femur, proximal femoral locking-plate fixation is a treatmentoption that results in fewer perioperative and postoperative cardiopulmonary events and surgical complications.Most patients can ambulate with or without an assistive device at the final follow-up.

Download Full-text

Comparison of Five Years Clinical and Radiological Outcomes between Progressive and Non-Progressive Wrist Osteoarthritis after Volar Locking Plate Fixation of Distal Radius Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500061 ◽

2019 ◽

Vol 24 (01) ◽

pp. 30-35 ◽

Cited By ~ 1

Author(s):

Takeshi Katayama ◽

Hiroshi Ono ◽

Shohei Omokawa

Keyword(s):

Clinical Outcomes ◽

Distal Radius ◽

Locking Plate ◽

Plate Fixation ◽

Distal Radius Fractures ◽

Volar Locking Plate ◽

Wrist Flexion ◽

Radius Fractures ◽

Locking Plate Fixation

Background: This study aimed to identify the effect of the progression of postoperative wrist osteoarthritis on 5 years clinical and radiological outcomes after volar locking plate fixation of distal radius fractures. Methods: Altogether, 56 patients with distal radius fractures were followed up 5 years after surgery. Clinical assessment was performed using the Mayo modified wrist score, a visual analogue scale of pain, the Japanese version of the Disabilities of the Arm, Shoulder, and Hand score, and Patient-related wrist evaluation. Standardized wrist radiographs were used to assess wrist morphology and the Knirk and Jupiter’s degree of osteoarthritis. Multivariate logistic regression was used to analyze postoperative morphological changes in the wrist and carpal alignment regarding their correlation with progression of wrist osteoarthritis. Results: Progression of postoperative wrist osteoarthritis was recognized in 37 of the 56 cases (66.1%). Compared with the clinical outcomes at the time of the fracture union completion, almost clinical outcomes improved up to 5 years follow-up time as well as at 1 year after surgery. The range of wrist flexion at 5 years follow-up was significantly less in the progressive osteoarthritis group than in those with non-progressive osteoarthritis. The persistent step-off immediately after surgery significantly affected the postoperative progression of wrist osteoarthritis. Changes in the radial inclination, volar tilt, and radioscaphoid angle correlated with progression of wrist osteoarthritis. The highest correlation was with the change of radioscaphoid angle. Conclusions: Good clinical results were maintained at 5 years after surgery, but progression of postoperative wrist osteoarthritis interfered with improvement of wrist flexion. Change in the radioscaphoid angle was the factor that was most highly correlated with progression of postoperative wrist osteoarthritis.

Download Full-text

Locking plate fixation for proximal humerus fractures—when do I use a fibular strut?

Annals of Joint ◽

10.21037/aoj-20-42 ◽

2020 ◽

Vol 5 ◽

pp. 44-44

Author(s):

Geoffrey P. Stone ◽

Kaitlyn N. Christmas ◽

Mark A. Mighell

Keyword(s):

Locking Plate ◽

Proximal Humerus ◽

Plate Fixation ◽

Proximal Humerus Fractures ◽

Locking Plate Fixation ◽

Humerus Fractures ◽

Fibular Strut

Download Full-text

Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: a prospective study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419899332 ◽

2020 ◽

Vol 45 (6) ◽

pp. 582-587

Author(s):

Takeshi Katayama ◽

Kazuhiko Furuta ◽

Hiroshi Ono ◽

Shohei Omokawa

Keyword(s):

Clinical Outcomes ◽

Locking Plate ◽

Plate Fixation ◽

Bony Union ◽

Complication Rates ◽

Locking Plate Fixation ◽

Level Of Evidence ◽

Finger Motion ◽

Phalangeal Fractures

We prospectively assessed clinical and radiological outcomes of locking plate fixation in treating unstable fractures in 11 metacarpals, 15 proximal phalanges, and eight middle phalanges in 34 consecutive patients from October 2011 to December 2016. Median length of follow-up was 14 months (range 12–24). The motion of finger joints, bony union, and complication rates were recorded. The median postoperative range of motion of the two interphalangeal joints and the metacarpophalangeal joint was 82% of the contralateral hands. Fractures in the three locations had significantly different recovery of the finger motion, with the best recovery for the metacarpal fractures. Closer distance between the plate edge and joint line was associated with a more limited range of the finger motion. The clinical outcomes approached an acceptable level at final follow-up. Finger stiffness is unavoidable after locking plate fixation of metacarpal and phalangeal fractures even with early hand therapy, with stiffness occurring in 10 out of 34 cases at the time of final follow-up 1 year after surgery. Level of evidence: II

Download Full-text