Clinics in Shoulder and Elbow

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

DOI QR Code

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

  • Lee, Kwang-Won (Department of Orthopedic Surgery, Eulji University College of Medicine) ;
  • Hwang, Yoon-Sub (Department of Orthopedic Surgery, Eulji University College of Medicine) ;
  • Kim, Choon-Myeon (Department of Orthopedic Surgery, Eulji University College of Medicine) ;
  • Yang, Dae-Suk (Department of Orthopedic Surgery, Eulji University College of Medicine) ;
  • Park, Tae-Soo (Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine)
  • Received : 2013.08.16
  • Accepted : 2014.01.20
  • Published : 2014.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

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.

Keywords

References

  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. https://doi.org/10.1016/j.injury.2006.04.130
  2. Oh JH, Kim YH. The current concepts in the treatment of proximal humerus fracture. J Korean Fract Soc. 2012;25(1):94-104. https://doi.org/10.12671/jkfs.2012.25.1.94
  3. Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7(6):612-8. https://doi.org/10.1097/00001648-199611000-00008
  4. Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75(6):741-5. https://doi.org/10.1080/00016470410004120
  5. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18(8):488-93. https://doi.org/10.1097/00005131-200409000-00003
  6. Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115-20. https://doi.org/10.1097/01.blo.0000194678.87258.6e
  7. Park CH, Park SH, Seo JS. Internal fixation of proximal humerus fracture with locking compression plate. J Korean Shoulder Elbow Soc. 2009;12(1):44-52. https://doi.org/10.5397/CiSE.2009.12.1.044
  8. Ha SS, Kim JY, Hong KD, Sim JC, Kang JH, Park KH. Operative treatment with locking compression plate (LCP) in proximal humerus fracture. J Korean Shoulder Elbow Soc. 2008;11(2):137-42. https://doi.org/10.5397/CiSE.2008.11.2.137
  9. Siwach R, Singh R, Rohilla RK, Kadian VS, Sangwan SS, Dhanda M. Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis. J Orthop Traumatol. 2008;9(3):149-53. https://doi.org/10.1007/s10195-008-0014-6
  10. Plecko M, Kraus A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol. 2005;17(1):25-50. https://doi.org/10.1007/s00064-005-1120-8
  11. Agudelo J, Schurmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma. 2007;21(10):676-81. https://doi.org/10.1097/BOT.0b013e31815bb09d
  12. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-4.
  13. Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P. Operative treatment of severe proximal humeral fractures. Acta Orthop Scand. 1983;54(3):374-9. https://doi.org/10.3109/17453678308996587
  14. 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
  15. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420-8. https://doi.org/10.1037/0033-2909.86.2.420
  16. 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
  17. Spross C, Platz A, Rufibach K, Lattmann T, Forberger J, Dietrich M. The PHILOS plate for proximal humeral fractures--risk factors for complications at one year. J Trauma Acute Care Surg. 2012;72(3):783-92. https://doi.org/10.1097/TA.0b013e31822c1b5b
  18. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;(430):176-81.
  19. 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
  20. Micic ID, Kim KC, Shin DJ, et al. Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures. J Orthop Sci. 2009;14(5):596-601. https://doi.org/10.1007/s00776-009-1382-3
  21. Roderer G, Erhardt J, Kuster M, et al. Second generation locked plating of proximal humerus fractures--a prospective multicentre observational study. Int Orthop. 2011;35(3):425-32. https://doi.org/10.1007/s00264-010-1015-7
  22. Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma. 2009;23(2):113-9. https://doi.org/10.1097/BOT.0b013e31819344bf
  23. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42(11):1283-8. https://doi.org/10.1016/j.injury.2011.01.017
  24. Osterhoff G, Hoch A, Wanner GA, Simmen HP, Werner CM. Calcar comminution as prognostic factor of clinical outcome after locking plate fixation of proximal humeral fractures. Injury. 2012;43(10):1651-6. https://doi.org/10.1016/j.injury.2012.04.015
  25. 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.
  26. Lee SH, Dargent-Molina P, Breart G; EPIDOS Group. Epidemiologie de l'Osteoporose Study. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res. 2002;17(5):817-25. https://doi.org/10.1359/jbmr.2002.17.5.817
  27. Doetsch AM, Faber J, Lynnerup N, Watjen I, Bliddal H, Danneskiold-Samsoe B. Bone mineral density measurement over the shoulder region. Calcif Tissue Int. 2002;71(4):308-14. https://doi.org/10.1007/s00223-001-2082-y
  28. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. J Bone Joint Surg Br. 2007;89(9):1206-9.