The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

BACKGROUND: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes.METHODS: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications.RESULTS: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient).CONCLUSIONS: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

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Outcome analysis of patients with proximal humerus fractures treated with locking plates

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171578 ◽

2017 ◽

Vol 3 (3) ◽

pp. 401

Author(s):

Ritesh Kumar ◽

S. Natarajan ◽

Sanjeev Kumar ◽

R. Kalanithi

Keyword(s):

Surgical Technique ◽

Functional Outcome ◽

Proximal Humerus ◽

Constant Score ◽

High Energy ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Proximal Humerus Fractures ◽

Locking Plates ◽

Humerus Fractures

Background: Fracture of proximal humerus incidence has been reported to be 73 cases per 100,000 individuals per year. There are different methods of treatment of proximal humeral fractures. The aim of our study is to analyse the functional outcome of proximal humerus fractures treated with proximal humerus locking plates and to analyse the possible benefits and complications of the procedure.Methods: This is a retrospective study of 34 patients with proximal humeral fractures treated with ORIF using Proximal humeral locking plates from October 2010 to November 2012 at Saifee Hospital, Mumbai. The cases are evaluated as regards to functional outcome using constant score, fracture healing clinically, radiologically and complications if any and reason for them.Results: Our study shows that proximal humerus fractures are now increasingly seen in younger population with good bone stock following high energy trauma. In elderly it was low energy trauma. The average time of radiological fracture union in our study was 10 weeks (8-16 weeks). The mean constant score at final follow up was 66.7 (35-90). A total of 17 patients (51%) had excellent or good results, but in 9 (27%) the outcome was poor. Eight (23%) complications were noted resulting in poor functional outcome. Conclusions: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. A reproducible standard surgical technique is absolutely necessary for improved patient outcome. Most of the complications in our study were related to the surgical technique. The precise surgical technique, stable fracture fixation and restoration of correct neck shaft angle are absolutely necessary for improved outcome.

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Clinical and radiological outcome of 3- and 4-part proximal humerus fracture managed with J nails in elderly osteoporotic individuals

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214177 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1122

Author(s):

R. M. Chandak ◽

Mohit Sharma ◽

Amrit Jha

Keyword(s):

Constant Score ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Radiological Outcome ◽

Neck Shaft Angle ◽

Clinical And Radiological Outcome ◽

Shaft Angle ◽

The Mean

Background: Proximal humeral fracture is 3rd most common fracture in elderly population. Selection of appropriate implant is always challenging to get optimum results in these osteoporotic bones. Though locking plates are gold standard, major complications range from 9% to 36%. To study clinical and radiological outcome of J nail technique for Neer’s three or four part proximal humeral fractures in patients more than 60 years age.Methods: We retrospectively studied 60 patients of 3 or 4 part proximal humeral fractures, >60 years of age treated with J nail technique from the period of 2015 to 2017. J nails were made using 2 mm 12 inches blunt tip Lambrinudi wires. At final follow-up, clinical outcome was assessed using constant score and radiological evaluation was done according to the Bahr criteria.Results: The mean constant score at final follow-up was 90. The postoperative reduction was excellent in 98% of patients and remained excellent in 90%. The mean postoperative neck shaft angle was 135.0° and final neck shaft angle was 131.4°. No deep infection was seen. No avascular necrosis of humeral head was found till follow up to 2 years.Conclusions: Our study suggests that the functional and radiological outcomes obtained with J nailing are excellent and similar to locking plates and percutaneous Kirschner wire fixation with many other advantages of being simple, minimally invasive, avoiding muscle transfixation and no pin site infections.

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T2.3 Is the peg better than the screw in the locking plates preventing penetration in proximal humeral fractures?

Injury ◽

10.1016/s0020-1383(13)70041-x ◽

2013 ◽

Vol 44 ◽

pp. S5

Author(s):

N. Aksu ◽

B. Abay ◽

R. Soydan ◽

C. Kopuz ◽

A.N. Kara ◽

...

Keyword(s):

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Better Than

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Serial changes in the head-shaft angle of proximal humeral fractures treated by placing locking plates: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-018-2349-3 ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Ji-Qi Wang ◽

Bing-Jie Jiang ◽

Wei-Jun Guo ◽

You-Ming Zhao

Keyword(s):

Retrospective Study ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Shaft Angle ◽

Head Shaft Angle

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Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis

International Orthopaedics ◽

10.1007/s00264-017-3683-z ◽

2017 ◽

Vol 42 (3) ◽

pp. 641-650 ◽

Cited By ~ 12

Author(s):

Qi Sun ◽

Wei Ge ◽

Gen Li ◽

Jiezhou Wu ◽

Guanghua Lu ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Locking Plates ◽

Intramedullary Nails

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Operative Choice for Displaced Proximal Humeral Fractures in Adolescents with Open Visible Physis: A Comparative Study of External Fixator vs. Kirschner Wire

10.21203/rs.3.rs-33678/v1 ◽

2020 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Huabing Qian ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Operative Time ◽

Rating Scale ◽

Demographic Data ◽

Kirschner Wire ◽

Humeral Fracture ◽

Good Choice ◽

Proximal Humeral Fractures ◽

Humeral Fractures

Abstract Background: For adolescents of severely displaced proximal humeral fracture (PHF), surgery is a good choice yielding excellent outcomes. Kirchner wire (KW) is a cost-effective choice for fixation, and this study aims to compare the clinical outcomes of external fixator (EF) vs. KW for the treatment of PHF in adolescents. To the best of our knowledge, it is the first report on external fixator for PHF in children and adolescents.Methods: Patients of PHF operated in our institute, from January 2008 to January 2016, were reviewed retrospectively. Demographic data, including sex, age at the time of surgery, operated side, and hardware choice, were collected from the hospital database. Preoperative radiographs were reviewed and classified according to Neer-Horwitz classification. Shoulder function was evaluated during 12th month follow-up using rating scale of the American shoulder and elbow surgeons (ASES). Complications, including infection, malunion, nonunion, stiffness of the shoulder joint, and failure of fixation were also recorded.Results: Thirty-five patients, including 23 males and 12 females, were included in the EF group, whereas 40 patients, including 25 males and 15 females, were included in the KW group (P = 0.867). The average age of patients in the EF group was 13.3 ± 1.7 years, and that of KW was 13.6 ± 1.8 years (P = 0.409). Patients in both groups were followed-up for at least 12 months. The operative time in the EF group (42.4 ± 11.2, min) was significantly shorter than those in the KW group (54 ± 13.6, min), P < 0.001. The frequency of fluoroscopy in the EF group (12 ± 2.4) was significantly less than those in the KW group (17 ± 2.8), P < 0.001. The rate of open reduction was significantly higher in KW (35%) group than those in the EF group (0%), P < 0.001. There was no nonunion, malunion cases in both groups.Conclusion: External fixator is superior to Kirschner wire in the treatment of proximal humeral fractures in adolescents with shorter operative time, lower rate of ORIF and comparable clinical outcomes.

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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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