Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

Aims The aim of this study was to explore why some calcar screws are malpositioned when a proximal humeral fracture is treated by internal fixation with a locking plate, and to identify risk factors for this phenomenon. Some suggestions can be made of ways to avoid this error. Methods We retrospectively identified all proximal humeral fractures treated in our institution between October 2016 and October 2018 using the hospital information system. The patients’ medical and radiological data were collected, and we divided potential risk factors into two groups: preoperative factors and intraoperative factors. Preoperative factors included age, sex, height, weight, body mass index, proximal humeral bone mineral density, type of fracture, the condition of the medial hinge, and medial metaphyseal head extension. Intraoperative factors included the grade of surgeon, neck-shaft angle after reduction, humeral head height, restoration of medial support, and quality of reduction. Adjusted binary logistic regression and multivariate logistic regression models were used to identify pre- and intraoperative risk factors. Area under the curve (AUC) analysis was used to evaluate the discriminative ability of the multivariable model. Results Data from 203 patients (63 males and 140 females) with a mean age of 62 years (22 to 89) were analyzed. In 49 fractures, the calcar screw was considered to be malpositioned; in 154 it was in the optimal position. The rate of malpositioning was therefore 24% (49/203). No preoperative risk factor was found for malpositioning of the calcar screws. Only the neck-shaft angle was found to be related to the risk of screw malpositioning in a multivariate model (with an AUC of 0.72). For the fractures in which the neck-shaft angle was reduced to between 130° and 150°, 91% (133/46) of calcar screws were in the optimal position. Conclusion The neck-shaft angle is the key factor for the appropriate positioning of calcar screws when treating a proximal humeral fracture with a locking plate. We recommend reducing the angle to between 130° and 150°. Cite this article: Bone Joint J 2020;102-B(12):1629–1635.

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Locking nail versus locking plate for proximal humeral fracture fixation in an elderly population: a prospective randomised controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2399-1 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 7

Author(s):

Johannes E. Plath ◽

Christian Kerschbaum ◽

Tobias Seebauer ◽

Rainer Holz ◽

Daniel J. H. Henderson ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Fracture Fixation ◽

Proximal Humeral Fracture ◽

Elderly Population ◽

Locking Plate ◽

Controlled Trial ◽

Humeral Fracture ◽

Locking Nail ◽

Randomised Controlled

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Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem?

International Orthopaedics ◽

10.1007/s00264-021-05284-y ◽

2022 ◽

Author(s):

Yaiza Lopiz ◽

Carlos García-Fernandez ◽

María Vallejo-Carrasco ◽

Daniel Garriguez-Pérez ◽

Loreto Achaerandio ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humeral Fracture ◽

Reverse Shoulder Arthroplasty ◽

Humeral Fracture ◽

The Elderly

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Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2907-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Xueliang Cui ◽

Hui Chen ◽

Binbin Ma ◽

Wenbin Fan ◽

He Li

Keyword(s):

Elderly Patients ◽

Clinical Outcomes ◽

Locking Plate ◽

External Rotation ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Head Height

Abstract Background Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods We retrospectively reviewed 60 patients (mean age, 72.75 years) with closed 3- or 4-part fractures, and a minimum of 2 years of follow-up. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p < 0.001] and NSA of 9.94° versus 3.12° [p < 0.001]) . The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p = 0.024] and ASES score of 72.80 vs 78.64 [p = 0.022]). The FA group showed better forward elevation (p = 0.010) and abduction (p = 0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p < 0.001). Conclusion For comminuted PHFs in elderly patients, LCP fixation combined with a fibular allograft is reasonable option to ensure satisfactory radiological and clinical outcomes. Trial registration ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. Date of registration: 2018-05-17.

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Fibular strut allograft influences reduction and outcome after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

10.21203/rs.2.11169/v1 ◽

2019 ◽

Author(s):

Xueliang Cui ◽

Hui chen ◽

Binbin Ma ◽

Wenbin Fan ◽

He Li

Keyword(s):

Locking Plate ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plate Fixation ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Head Height ◽

Fibular Strut ◽

Fibular Strut Allograft

Abstract Purpose: The purpose of this study was to determine if fibular strut allograft influence reduction and clinical outcomes after locking plate fixation of comminuted proximal humeral fractures (PHFs). Methods: A retrospective review was performed on sixty 3- and 4-part PHFs treated with either locking plate only or locking plate with a fibular allograft. Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5°or if the change of humeral head height (HHH) was more than 3 mm. Clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result: The average radiological changes were higher in the locking compression plate (LCP) group than in the locking plate with fibular allograft (FA) group ( HHH of 4.16mm versus 1.18mm [p﹤0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). Final average outcome scores were lower in LCP group than in FA group ( CMS of 73.00 versus 78.96 [p = 0.024] and ASES score of 72.80 versus 78.64 [p = 0.022]). FA group showed better forward elevation (P=0.010) and abduction (P=0.002), but no significant differences were observed for shoulder external rotation or internal rotation. Conclusion: For comminuted proximal humerus fractures in elderly patients with severe osteoporosis, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Key words: proximal humeral fractures; locking compression plate; fibular allograft

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Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study

10.21203/rs.2.11169/v2 ◽

2019 ◽

Author(s):

Xueliang Cui ◽

Hui chen ◽

Binbin Ma ◽

Wenbin Fan ◽

He Li

Keyword(s):

Elderly Patients ◽

Clinical Outcomes ◽

Locking Plate ◽

Plate Fixation ◽

Humeral Fractures ◽

Locking Plate Fixation ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Fibular Strut ◽

Fibular Strut Allograft

Abstract Abstract Background: Proximal humeral fractures (PHFs) are the third most commonly occurring fractures in elderly patients. Most of these fractures can be treated with conservative methods, but the optimal surgical treatment strategy for unstable fractures in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes between locking compression plate (LCP) fixation and LCP fixation with fibular allograft implantation for the treatment of comminuted PHFs. Methods: A retrospective review was performed on 60 three- and four-part PHFs . The outcomes were assessed for 35 patients in the LCP group and 25 in the LCP with fibular allograft (FA) group, with a mean age of 72.75 years (60 to 88), at a mean follow-up of 31.95 months (24 to 40). Fracture reduction was quantitatively determined by humeral head height (HHH) and neck-shaft angle (NSA). Loss of anatomic fixation was defined if the varus malalignment of the neck-shaft angle (NSA) was more than 5° or if the change in HHH was more than 3 mm. The clinical outcome was evaluated by Constant-Murley score (CMS) and American Shoulder and Elbow Surgeons (ASES) score. Result: The average radiological changes were higher in the LCP group than in the locking plate with fibular allograft group (HHH of 4.16 mm vs 1.18 mm [p<0.001] and NSA of 9.94° versus 3.12° [p﹤0.001 ]). The final average outcome scores were lower in the LCP group than in the FA group (CMS of 73.00 vs 78.96 [p=0.024] and ASES score of 72.80 vs 78.64 [p=0.022]). The FA group showed better forward elevation (p=0.010) and abduction (p=0.002); however, no significant differences were observed for shoulder external rotation or internal rotation. The number of complications was higher in the LCP group (28.57%) than in the FA group (1.2%) (p<0.001). Conclusion: For comminuted PHFs in elderly patients, locking plate fixation with a fibular strut allograft showed satisfactory radiological and clinical outcomes. Trial registration: ZDYJLY(2018)New-9. Name of registry: IEC for clinical Research of Zhongda Hospital, Affiliated to Southeast University. URL of registry: http://www.njzdyy.com. Date of registration: 2018-05-17 Key words: proximal humeral fracture; fibular allograft; locking plate; elderly patients

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TO EVALUATE THE EFFICACY OF KICK STAND SCREW IN FIXATION OF SUBTROCHANTERIC FEMORAL FRACTURES USING CONTRALATERAL REVERSED DISTAL FEMORAL LOCKING PLATEPROSPECTIVE SINGLE CENTRIC STUDY

10.36106/ijar/9401597 ◽

2020 ◽

pp. 1-4

Author(s):

Prashant Pandey ◽

K K Pandey ◽

Ajay Dhanopeeya ◽

Surya Prakash Garg

Keyword(s):

Proximal Femur ◽

Locking Plate ◽

Harris Hip Score ◽

Plate Bending ◽

Neck Shaft Angle ◽

Subtrochanteric Fractures ◽

Proximal Femur Fractures ◽

Femur Fractures ◽

Shaft Angle

PURPOSE- All type of plates when used for proximal femur fractures always has chances of mechanical failure due to lack of strength of the construct, but addition of ‘kick stand screw’ has some effects on stability of the construct. Aim of our study is to evaluate the efficacy of kick stand screw in fixation of subtrochanteric fractures using contralateral reversed distal femoral locking plate. METHOD- 30 patients of subtrochanteric fractures fixed using contralateral reversed distal femoral locking plate. N(1st)=15 fixed without kick stand screw and other N(2nd)=15 fixed using kick stand screw. Calcar screw( Kick Stand Screw) is placed to support calcar region (inferior to the center in AP view and central in Lateral view). In other group screws are placed as oriented in screw holes. Outcome was assessed using Harris Hip Score and VAS score and change in the neck shaft angle is also followed. RESULT- Union rate was 80% in 1st group as compare to 94% in second group. Mean Harris hip score at the one year follow up was 71.2 in 1st group as compare to 89.2 in 2nd group. Mean Visual analogue scale was 3.2 in first group as compare to 1.6 in second group at final follow up. Mean neck shaft angle at final follow-up was 120 degree in first group as compared to135 degree in second group. Complication- 1st Group of patients had three failures 2 in the form of screw break down and one in the form of plate bending, all three lend up in to varus deformity but the 2nd group had only one failure in the form of plate bending. CONCLUSION-In our study cases in which kick stand screw was used they showed better mechanical strength and gave better clinical results. So in proximal femur fractures including subtrochanteric fracture fixation ‘kick stand screw’ must be used.

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Impact of Comprehensive Nursing on Proximal Humeral Fracture Treated with Locking Plate through Subacromial Small Incision

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v1i3.155 ◽

2017 ◽

Vol 1 (3) ◽

Author(s):

Yan Li

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Proximal Humeral Fracture ◽

Locking Plate ◽

Statistical Significance ◽

Humeral Fracture ◽

Nursing Intervention ◽

Control Group ◽

Small Incision ◽

The Impact

Objective:Probe into the impact of comprehensive nursingintervention on clinical efficacy of 45 cases of patients withproximal humeral fracture treated with locking plate throughsubacromial small incision. Method: equally divide 90 cases ofpatients with proximal humeral fracture into an observation groupand a control group in a random manner. Both of the two groupswere treated with locking plate through subacromial small incision.Give routine orthopedic nursing to the control group, whileimplementing comprehensive nursing intervention on the basis ofroutine orthopedic nursing to observation group, including mentalintervention, comfortable nursing, recovery nursing, etc. Comparethe nursing efficacy of the two groups. Result: operations werecompleted in small incision to cases of both groups. By adoptingConstant scoring method and ASES and through statisticaltreatment, the differences in blood loss, operation time andduration of postoperative pain of patients with those applyingtraditional internal plate fixation, replacement of the humeral headand treatment with locking plate through deltoid & pectoralismajor have statistical significance (P ï¼œ 0.05). The duration ofpostoperative pain of patients is shortened and the blood loss isless. Conclusion: implementing the comprehensive nursingintervention to patients with proximal humeral fracture treatedwith locking plate through subacromial small incision can improvethe treatment effect, alleviate the postoperative pain, lower theoccurrence rate of complications, and improve prognosis as well aslife quality. The clinical effect is satisfying.

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Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series

10.21203/rs.2.14214/v2 ◽

2019 ◽

Author(s):

Won Chul Shin ◽

Suk-Woong Kang ◽

Seung Min Son ◽

Hyuk Bae

Keyword(s):

Surgical Treatment ◽

Locking Plate ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Bone Union ◽

Neck Shaft Angle ◽

Radiological Results ◽

Comminuted Fracture ◽

Shaft Angle ◽

The Mean

Abstract Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years. Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not. Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture. Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.

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Augmentation of a Locking Plate System Using Bioactive Bone Cement—Experiment in a Proximal Humeral Fracture Model

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318795312 ◽

2018 ◽

Vol 9 ◽

pp. 215145931879531 ◽

Cited By ~ 4

Author(s):

Guan-Ming Kuang ◽

Tak Man Wong ◽

Jun Wu ◽

Jun Ouyang ◽

Haihua Guo ◽

...

Keyword(s):

Bone Cement ◽

Proximal Humeral Fracture ◽

Locking Plate ◽

Humeral Fracture ◽

Fracture Model ◽

Bending Test ◽

Control Group ◽

X Ray ◽

Locking Plate System ◽

Plate System

Introduction: The purpose of this study was to test whether local filling of a novel strontium-containing hydroxyapatite (Sr-HA) bone cement can augment the fixation of a locking plate system in a cadaveric proximal humeral facture model. Materials and Methods: Twelve pairs of formalin-treated cadaveric humeri were used. One side in each pair was for cemented group, while the other side was for the control group. The bone mineral density (BMD) of the samples was tested. A 3-part facture model was created and then reduced and fixed by a locking plate system. In the cemented group, the most proximal 4 screw holes were filled with 0.5 mL bone cement. In the control group, the screw holes were not filled by cement. Locking screws were inserted in a standard manner before the cement hardened. X-ray was taken before all the specimens being subjected to mechanical study, in which 6 pairs were used for axial loading (varus bending) test, while other 6 pairs were used for axial rotational test. Results: There is no difference in BMD between the cemented side and the control side. The X-ray shows that the implant is in position. Cement filling was noted in the most proximal 4 screws in the cemented group. Better mechanical outcome was seen in the cemented groups, in terms of less maximal displacement per cycle and higher failure point and stiffness in varus bending test. However, no difference was found between the cemented group and the control group in the axial rotation test. Discussion: In similarity with the previous studies, our results showed better mechanical results in the cemented group. However, due to the limitations (e.g. sample size, fracture model, testing protocol, etc), we still cannot directly extrapolate current mechanical results to clinical practice at the present moment. Furthermore, it is still unknown whether better primary outcome may lead to better long-term results, even though the local release of strontium may enhance the local bone formation. Conclusion: The local filling of Sr-HA bone cement augments the fixation of the locking plate system in current proximal humeral fracture model.

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