Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures

Proximal humerus fractures account for about 4% to 5% of all fractures. Following distal forearm fracture, proximal humeral fracture is the second most common upper extremity fracture. Kirschner (K)-Wires, external fixation, tension band wiring, and rush pins, intramedullary nails, ORIF with plates, and shoulder hemiarthroplasty have all been offered as therapeutic options. The purpose of this study was to assess the functional outcome and complication rates following internal fixation of proximal humerus fractures using a locking compression plate. Patients over the age of 18 with closed proximal humerus fractures or open proximal humerus fractures (Gustilo and Anderson type I, Type II) received open reduction and internal fixation with locking compression plate in the current study. The participants in this study were 60 people who had a proximal humerus fracture and were treated with open reduction and a proximal humerus locking compression plate. Patients ranged in age from 20 to 85 years old, with a mean age of 51.14 +/- 17.30 years. The age group 36–55 years (37 percent) was the most prevalent, followed by 56–75 years (30 %). The majority of patients (76.7 %) were men who had been in automobile accidents on the right side (83 %) (63 %). According to the Neer classification, the most prevalent type of fracture was a three-part fracture (53 %). The maximum union time observed in this study was 16 weeks, with a minimum of 10 weeks. The average time to union is 12.52 +/- 1.14 weeks. The mean flexion at the end of six months was 121.660 +/- 19.84. The mean internal rotation was 57.330 +/- 8.48, the mean external rotation was 530 +/- 11.98, and the mean abduction was 1180 +/- 19.36. 75.28 +/- 9.66 [Mean +/- SD] is the Mean Constant score. Pain 14.10, ADL 18.26, range of motion 22.46, and power 20 were the mean scores observed on Constant Score for its various aspects. According to the Constant score, the functional outcome of the 60 patients was as follows: 8 patients had excellent outcomes (13%), 34 patients had good outcomes (56.7%), 16 patients had moderate outcomes (26.7%), and two patients had poor outcomes (26.7%) and (3 %). Internal fixation of proximal humerus fractures with a locking compression plate results in anatomical reduction and secure fixation, resulting in a favorable functional outcome.

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Surgical management of proximal humerus fracture treated with locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174707 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1165

Author(s):

Sivakumar Arumugam ◽

Venkateshwara Arumugam ◽

V. Raviraman

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Proximal Humerus ◽

Early Mobilization ◽

Open Reduction Internal Fixation ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Comminuted Fractures ◽

Humerus Fractures

Background: Proximal humerus fractures accounts for about 4 to 5% of all fractures. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remain challenging. Significant controversy continues regarding the best methods of treating displaced proximal humerus fractures. Various operative procedures are carried out, the recent trend in internal fixation has moved on to locking plates. The present study is undertaken to evaluate the functional outcome and complication of proximal humerus fractures treated by locking compression plate.Methods: This is a prospective study comprising of 30 patients with fractures of proximal humerus were treated by open reduction and internal fixation with locking compression plate were evaluated at Velammal Institute Of Medical Sciences, Madurai from the period of April 2015 to December 2016. Clinical and radiological evaluation was done. Patients will undergo open reduction internal fixation with locking compression plate for the sustained fracture under general anesthesia.Results: In our series, the majority of the patients were males, elderly aged, with RTA being the commonest mode of injury, involving 2 part, 3 part and 4 part fractures of the proximal humerus. Excellent and satisfactory results were found in 76.7% of patients with unsatisfactory results in 23.3 % according to Neer’s criteria. There were 100 % union rates and no failures.Conclusions: In conclusion locking Compression, the plate is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in Osteoporotic bones in elderly patients, thus allowing early mobilization.

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Comparative study of functional outcome of minimally invasive plate Osteosynthesis versus open reduction and internal fixation with locking compression plate in distal 1/3rd shaft tibia fractures (Extraarticular)

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i4c.1664 ◽

2019 ◽

Vol 5 (4) ◽

pp. 149-152

Author(s):

Dr. Sanjeev Sreen ◽

Dr. Girish Sahni ◽

Dr. Sanjeev Kumar ◽

Dr. Ayush Kumar Jain ◽

Dr. Tarun Behl

Keyword(s):

Minimally Invasive ◽

Comparative Study ◽

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Plate Osteosynthesis ◽

Locking Compression Plate ◽

Minimally Invasive Plate Osteosynthesis ◽

Compression Plate ◽

Tibia Fractures

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Study of functional outcome of proximal humerus fractures managed by open reduction and internal fixation with locking compression plate at a tertiary hospital

MedPulse International Journal of Orthopedics ◽

10.26611/10201721 ◽

2020 ◽

Vol 17 (2) ◽

pp. 15-19

Author(s):

Snehal Hedgire ◽

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Tertiary Hospital ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures

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Functional outcome of displaced proximal humerus fractures treated conservatively versus open reduction internal fixation with locking compression plate

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i1h.72 ◽

2018 ◽

Vol 4 (1h) ◽

pp. 504-509

Author(s):

Dr. Natesh Kolusu ◽

S K Peddamadyam Anjaneyulu

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Proximal Humerus ◽

Open Reduction Internal Fixation ◽

Locking Compression Plate ◽

Proximal Humerus Fractures ◽

Compression Plate ◽

Humerus Fractures

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Minimally invasive plate osteosynthesis (MIPO) in diaphyseal humerus and proximal humerus fractures

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2012.2592 ◽

2012 ◽

Vol 46 (3) ◽

pp. 154-160 ◽

Cited By ~ 13

Author(s):

Neslihan Aksu

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Humerus Fractures

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Minimally Invasive Plate Osteosynthesis for Proximal Humerus Fractures: A Retrospective Study Describing Principles and Advantages of the Technique

Advances in Orthopedics ◽

10.1155/2018/5904028 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Riccardo Luigi Alberio ◽

Matteo Del Re ◽

Federico Alberto Grassi

Keyword(s):

Minimally Invasive ◽

Proximal Humerus ◽

Plate Osteosynthesis ◽

Humeral Fractures ◽

Radiographic Evaluation ◽

Minimally Invasive Plate Osteosynthesis ◽

Proximal Humerus Fractures ◽

Greater Tuberosity ◽

Humerus Fractures ◽

The Mean

Background. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis (MIPO) for proximal humerus fractures. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Materials and Methods. From October 2011 to March 2016, thirty-nine patients (32 women, 7 men) with a mean age of 64.9 years (range: 48–80) were surgically treated with the MIPO technique for proximal humeral fractures. According to Neer classification, there were 12 two-part, 24 three-part, and 2 four-part fractures and 1 two-part fracture-dislocation; the AO/OTA system was also used to categorize the fractures. The Constant-Murley (CMS) and the Oxford Shoulder (OSS) Scores were used to evaluate shoulder function. Results. Thirty-four patients were available for clinical and radiographic evaluation at a mean follow-up of 31.8 months (range: 12–54 months). All fractures healed and no postoperative complications occurred. Full recovery of pretrauma activities was reported by 27 patients, while 7 patients presented mild functional limitations. The mean absolute CMS was 75.2 (range: 55–95), the mean normalized CMS was 90.5 (range: 69–107), and the mean OSS was 43.7 (range: 31–48). The only statistically significant correlation was found between the female gender and lower absolute CMS and OSS. Radiographic evaluation revealed varus malunion in 4 cases and valgus malunion in 1 case, while incomplete greater tuberosity reduction was detected in 4 cases. All malunions were related to inadequate reduction at time of surgery and not to secondary displacement. Conclusions. MIPO for proximal humeral fractures is an effective and safe surgical procedure. The limited tissue dissection allows minimizing the incidence of nonunion, avascular necrosis, and infection. The technique is not easy, requires experience to achieve mastery, and should be reserved for selected fracture patterns. In our experience, the main advantage of this approach consists in the direct access to the greater tuberosity, thus facilitating its anatomic reduction and fixation.

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