Results of surgical management of unstable proximal humeral fractures by proximal humeral locking plate
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242377Keywords:
Fracture, Locking plate, Management, Proximal humerusAbstract
Background: Unstable fractures of the proximal humerus present a significant surgical challenge despite the variety of treatment options available. One effective surgical method for managing these fractures is the use of a proximal humerus locking plate. This approach provides stability and support to the fracture site, facilitating proper healing and potentially improving patient outcomes. The aim of this study was to evaluate the outcome of treatment of unstable proximal humeral fractures with proximal humeral locking plate.
Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 100 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study.
Results: The mean age of patients with unstable proximal humerus fractures was 41.53 years, ranging from 23 to 78 years. Most patients were male and primarily in business occupations. Fracture types included three-part fractures (53%), four-part fractures (7%), and fracture dislocations (40%). The mean time to plate fixation was 18 days, with a range of 2 to 78 days. High-velocity accidents caused 93% of injuries. Complications included avascular necrosis (7%), screw loosening (7%), and subacromial impingement (13%), with no reoperations needed.
Conclusions: The result of the study demonstrates that the proximal humeral locking plate provides sufficient fracture stabilization in the treatment of unstable proximal humeral fractures.
References
Chadwick R, Kyle RF. 'Fractures and dislocation of the proximal humerus, scapula, stemoclavicular joint, acromioclavicular joint and clavicle'. In: Gustilo RB, Kyle RF, Templeman D, editors. Fractures and Dislocations. Vol I. St. Louis: Mosby-Yearbook Inc.; 2009:255-340.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthopaed Scandin. 2001;72(4):365-71.
Kristiansen B, Kofoed H. External fixation of displaced fractures of the proximal humerus. Technique and preliminary results. J Bone Joint Surg British Volume. 1987;69(4):643-6.
Strohm PC, Köstler W, Südkamp NP. Locking plate fixation of proximal humerus fractures. Techn Should Elbow Surg. 2005;6(1):8-13.
Duralde XA, Leddy LR. The results of open reduction and internal fixation of displaced proximal humeral fractures using a locking plate. J Shoul Elbow Surg. 2009;18:1-9.
Ko JY, Yamamoto R. Surgical treatment of complex fracture of the proximal humerus. Clin Orthopaed Relat Res. 1996;327:225-37.
Charles S NEER II. Displaced proximal humeral fractures: Part I. Classification and evaluation. JBJS. 1970;52(6):1077-89.
Codman EA. Rupture of the supraspinatus-1834 to 1934. JBJS. 1937;19(3):643-52.
Korkmaz M, Aksu N, Gogus A, Debre M, Kara A, Isiklar Z. The results of internal fixation of proximal humeral fractures with the PHILOS locking plate. Acta Orthopaed Traumatol Turci. 2008;42(2):97-105.
Fazal MA, Haddad FS. Philos plate fixation for displaced proximal humeral fractures. J Orthopaed Surg. 2009;17(1):15-8.
Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. JBJS. 2009;91(7):1689-97.
Young TB, Wallace WA. Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus. J Bone Joint Surg Brit. 1985;67(3):373-7.
Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Brit. 2000;82(8):1107-12.
Zyto K, Ahrengart L, Sperber A, Törnkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Brit. 1997;79(3):412-7.
S II NC. Displaced Proximal Humeral Fractures. Part II. Treatment of three-part and four-part displacement. J Bone Joint Surg. 1970;52:1090-103.
Jaberg H, Warner JJ, Jakob RP. Percutaneous stabilization of unstable fractures of the humerus. JBJS. 1992;74(4):508-15.
Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand. 1986;57(4):320-3.
Friess DM, Attia A, Vallier HA. Locking plate fixation for proximal humerus fractures: a comparison with other fixation techniques. Orthoped. 2008;31(12):1183.
