Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Indirect Reduction Technique in Proximal Humeral Fractures Stabilized by Locking Plates

  • Rhee, Yong Girl (Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Cho, Nam Su (Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Cha, Sang Won (Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Moon, Seong Cheol (Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Hwang, Sang Phil (Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • Received : 2013.12.02
  • Accepted : 2014.03.17
  • Published : 2014.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a locking plate. Methods: Twenty four patients with acute proximal humerus fracture were managed with indirect reduction and internal fixation with a locking plate. The mean follow-up period was 15.5 months. Results: The anatomical reduction of the medial cortex buttress was seen in 16 patients (66%) of the Group A and the non-anatomical reduction was seen in 8 patients (33%) of the Group B. Mean union time was $3.2{\pm}1.9$ months; it was $2.2{\pm}0.6$ months in the Group A and $5.3{\pm}2.2$ months in the Group B (p < 0.05). In our series, there were 6 cases of complications and these include 2 cases of varus malunion, 2 cases of shoulder stiffness, 1 case of heterotrophic ossification, 2 cases of screw perforation and 1 case of impingement. Conclusions: We conclude from our studies that indirect reduction and internal fixation using locking plate for acute proximal humerus fracture can give good results with bony union and predictable good overall functional outcome. If the medial cortex buttress is well maintained, a better anatomical reduction would be achieved, the union would be prompted, the pain would be further reduced and the range of the motion would be recovered more promptly.

Keywords

References

  1. Bigliani LU, McCluskey GM 3rd. Prosthetic replacement in acute fractures of the proximal humerus. Semin Arthroplasty. 1990;1(2):129-37.
  2. Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108(5):285-7. https://doi.org/10.1007/BF00932316
  3. Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85-A(7):1215-23.
  4. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87-92. https://doi.org/10.1097/01.blo.0000194672.79634.78
  5. Fjalestad T, Stromsoe K, Blucher J, Tennoe B. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg. 2005;125(5):310-6. https://doi.org/10.1007/s00402-005-0803-9
  6. Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009;18(4):612-21. https://doi.org/10.1016/j.jse.2009.03.024
  7. Hessmann MH, Korner J, Hofmann A, Sternstein W, Rommens PM. Angle-fixed plate fixation or double-plate osteosynthesis in fractures of the proximal humerus: a biomechanical study. Biomed Tech. 2008;53(3):130-7. https://doi.org/10.1515/BMT.2008.018
  8. Robinson CM, Amin AK, Godley KC, Murray IR, White TO. Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma. 2011;25(10):618-29. https://doi.org/10.1097/BOT.0b013e31821c0a2f
  9. Aggarwal S, Bali K, Dhillon MS, Kumar V, Mootha AK. Displaced proximal humeral fractures: an Indian experience with locking plates. J Orthop Surg Res. 2010;5:60. https://doi.org/10.1186/1749-799X-5-60
  10. Robinson CM, Wylie JR, Ray AG, et al. Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate. J Bone Joint Surg Br. 2010;92(5):672-8.
  11. Schumer RA, Muckley KL, Markert RJ, et al. Biomechanical comparison of a proximal humeral locking plate using two methods of head fixation. J Shoulder Elbow Surg. 2010;19(4):495-501. https://doi.org/10.1016/j.jse.2009.11.003
  12. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12(4):205-12. https://doi.org/10.5435/00124635-200407000-00001
  13. Papadopoulos P, Karataglis D, Stavridis SI, Petsatodis G, Christodoulou A. Mid-term results of internal fixation of proximal humeral fractures with the Philos plate. Injury. 2009;40(12):1292-6. https://doi.org/10.1016/j.injury.2009.03.008
  14. Foruria AM, Carrascal MT, Revilla C, Munuera L, Sanchez-Sotelo J. Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: the role of implant stiffness. Clin Biomech. 2010;25(4):307-11. https://doi.org/10.1016/j.clinbiomech.2010.01.009
  15. Walsh S, Reindl R, Harvey E, Berry G, Beckman L, Steffen T. Biomechanical comparison of a unique locking plate versus a standard plate for internal fixation of proximal humerus fractures in a cadaveric model. Clin Biomech. 2006;21(10):1027-31. https://doi.org/10.1016/j.clinbiomech.2006.06.005
  16. Olsson C, Nordqvist A, Petersson CJ. Increased fragility in patients with fracture of the proximal humerus: a case control study. Bone. 2004;34(6):1072-7. https://doi.org/10.1016/j.bone.2004.01.009
  17. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185-91. https://doi.org/10.1097/BOT.0b013e3180333094
  18. Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br. 2003;85(4):611-7. https://doi.org/10.1302/0301-620X.85B4.12843
  19. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4.
  20. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44.
  21. Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int. 2005;16 Suppl 2:S65-72. https://doi.org/10.1007/s00198-004-1714-2
  22. Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13(4):427-33. https://doi.org/10.1016/j.jse.2004.01.034
  23. Bastian JD, Hertel R. Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg. 2008;17(1):2-8. https://doi.org/10.1016/j.jse.2007.03.026
  24. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91(7):1689-97. https://doi.org/10.2106/JBJS.H.00133
  25. Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury. 2008;39(3):306-13. https://doi.org/10.1016/j.injury.2007.10.011
  26. Hessmann M, Baumgaertel F, Gehling H, Klingelhoeffer I, Gotzen L. Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores. Injury. 1999;30(7):453-62. https://doi.org/10.1016/S0020-1383(99)00111-4
  27. Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:85-95. https://doi.org/10.2106/JBJS.I.01462
  28. Kuner EH. Fractures of the proximal humerus. Classification and treatment principles. Z Unfallchir Versicherungsmed. 1992;85(3):156-62.
  29. Sturzenegger M, Fornaro E, Jakob RP. Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg. 1982;100(4):249-59. https://doi.org/10.1007/BF00381665
  30. Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg. 2009;18(6):837-44. https://doi.org/10.1016/j.jse.2009.06.004
  31. Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S. Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury. 2012;43(2):153-8. https://doi.org/10.1016/j.injury.2011.04.003
  32. Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86(6):848-55. https://doi.org/10.1302/0301-620X.86B6.14577
  33. Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M. Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS(R) and hemiarthroplasty. Clin Orthop Relat Res. 2012;470(7):2035-42. https://doi.org/10.1007/s11999-011-2207-1
  34. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22(3):159-64. https://doi.org/10.1097/BOT.0b013e318169ef2a

Cited by

  1. Conventional plate fixation method versus pre-operative virtual simulation and three-dimensional printing-assisted contoured plate fixation method in the treatment of anterior pelvic ring fracture pp.1432-5195, 2018, https://doi.org/10.1007/s00264-018-3963-2