Management of Proximal Humeral Fractures with Proximal Humerus Locking Plate—A Prospective Study

With a varus deformity, repairs of proximal humeral fractures frequently fail after screws pull out due to lack of medial support. Indirect intramedullary grafts have been used to prevent such complications. A biomechanical study was performed to investigate the role of an intramedullary bone peg (strut) in fractures fixed with conventional and locking plates. Twenty artificial proximal humerus specimens were divided into four groups. Group 1 specimens were fixed with convention plates and group 2 specimens were fixed with the addition of a bone peg. Groups 3 and 4 specimens were fixed using locking plate and additional bone peg, respectively. All specimens were tested with a static loading test, and the axial stiffness and maximal load were recorded. Locking plates with inlay graft were the most rigid of the four groups. When an intramedullary graft was introduced, the maximal load increased by more than 200%, whether conventional or locking plates were used. The maximal load of a conventional plate with inlay graft was more than twice of that of the locking plate only. Indirect medial support acts as an anti-bending device, reducing the tension on the plate. It also decreases varus deformity and loosening of screws. Locking plate stabilize the plate-bone interface. Locking plate with indirect medial support is thus recommended for patients withsevere osteoporotic or medial comminuted proximal humeral fractures.

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Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195813 ◽

2019 ◽

Vol 6 (1) ◽

pp. 178

Author(s):

N. V. Narasimha Rao ◽

K. Ravi Kanth ◽

Rama Priya Yasam ◽

T. Jaya Chandra

Keyword(s):

Functional Outcome ◽

Locking Plate ◽

Proximal Humerus ◽

Shoulder Function ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Medical College ◽

Score Improvement ◽

Average Improvement

Background: The management of proximal humerus fractures (PHF) is a challenging task to any surgeon. Study was conducted to evaluate the clinical and functional outcome of the proximal humeral internal locking system in fixation of displaced proximal humeral fractures.Methods: Study was conducted in the Department of Orthopedics, GSL Medical College. Informed written consent was taken from the study participants. All skeletally mature patients aged >18 years, presenting with displaced PHF according to Neer two, three and four part fracture were included in the study. Either deltopectoral or deltoid splitting approach was used for surgery, post-operative rehabilitation was started on day one.Results: Twenty-five patients with PHF were enrolled in the study; five-holed proximal humerus locking plate (PHLP) was used for 18 patients, eight-holed PHLP for 05 and three-holed, ten-holed PHLP for 01 for one each. The Constant-Murley score was significantly improved (p=0.000) over each successive follow-up period with the average improvement of around 19 scores between 1st and 2nd follow-up and around 15 score improvement between 2nd and 3rd follow-up.Conclusions: The proximal humeral locking plate is an adequate device for the fixation of displaced two-part, three-part and four-part PHF. Patient can regain good shoulder function, resume normal activities much earlier.

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