The Outcome of Proximal Humeral Locking Plates in the Management of Three and Four Part Proximal Humeral Fractures in Special Cohort of Young Patients in High Velocity Trauma

Document Type : RESEARCH PAPER

Authors

KG Hospital and Post Graduate Medical Institute, Coimbatore, Tamil nadu, India

Abstract

Background: Locking plate fixation provides satisfactory outcome following proximal humerus fractures. None of the
previous studies selectively evaluate the outcome in young patients. This study evaluates outcome of locking plate
system in the treatment of acute three- and four-part fractures in young patients.
Methods: In this prospective study we included all patients who were less than 60 years, involved in high velocity
trauma, had proximal humerus comminuted three part and four part fractures and were operated using locking plate
at our centre, between August 2011 to August 2015. All the patients were followed up regularly. Assessment was done
clinically using Constant and Murley scoring system and radiologically using signs of healing in the form of callus
formation and cortical continuity.
Results: Twenty-five eligible patients were operated during the study period. All patients were involved in motor vehicle
collision. Average age of our patients was 41.2. The average duration of follow-up was 18.2 months(8 months to 27
months). 24 out of 25 fractures united clinically and radiologically at three months’ follow-up. Average Constant and
Murley score at final follow-up was 78.52. The results were excellent to good in 15 patients, fair in five patients and poor
in five patients. Overall complication rate was 24%. Majority of them (20%) were restriction of movements of shoulders.
None of our patients needed reoperation.
Conclusion: Locking plate system, in three part and four part proximal humerus fractures in young patients, provides
secure and stable fracture fixation for early mobilization. Early results with locking plate system were promising in
younger patients. In these patients, locking plate system has definite role to preserve the humeral head and there by
maintain the functional activity level.

Keywords

Main Subjects

References

1. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72(4):365-71.
2. Green A, Norris T. Proximal humerus fractures and fracture dislocations. Philadelphia: Saunders; 2003. P.1532-624.
3. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-4
4. Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009; 23(3):163-72.
5. Gardner MJ, Lorich DG, Werner CM, Helfet DL. Secondgeneration concepts for locked plating of proximal humerus fractures. Am J Orthop (Belle Mead NJ). 2007; 36(9):460-5.
6. Hall JA, Phieffer LS, McKee MD. Humeral shaft split fracture around proximal humeral locking plates: a report of two cases. J Orthop Trauma. 2006; 20(10):710-4.
7. Khunda A, Stirrat AN, Dunlop P. Injury to the axillary artery, a complication of fixation using a locking plate. J Bone Joint Surg Br. 2007; 89(11):1519-21.
8. Smith AM, Mardones RM, Sperling JW, Cofield RH. Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg. 2007;16(1):14-24.
9. Tolat AR, Amis A, Crofton S, Sinha J. Failure of humeral fracture fixation plate in a young patient using the Philos system: case report. J Shoulder Elbow Surg. 2006; 15(6):e44-7.
10. Voigt C, Woltmann A, Partenheimer A, Lill H. [Management of complications after angularly stable locking proximal humerus plate fixation. Chirurg.2007; 78(1):40-6.
11. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970; 52(6):1090-103.
12. Müller ME, Allgöwer M. Manual of internal fixation:techniques recommended by the AO-ASIF group.Berlin, Germany:Springer Science & Business Media; 1991.
13. Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures: epidemiology and outcome in 507 cases. Acta Orthop Scand. 2003;74(5):580-5.
14. Keener JD, Parsons BO, Flatow EL, Rogers K, Williams GR, Galatz LM. Outcomes after percutaneous reductionand fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2007; 16(3):330-8.
15. Fenichel I, Oran A, Burstein G, Perry M. Percutaneous pinning using threaded pins as a treatment option for unstable two-and three-part fractures of the proximal humerus: a retrospective study. Int Orthop. 2006;30(3):153-7.
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 (Bristol, Avon). 2006; 21(10):1027-31.
17. Seide K, Triebe J, Faschingbauer M, Schulz AP, Püschel K, Mehrtens G, et al. Locked vs. unlocked plate osteosynthesis of the proximal humerus - a biomechanical study. Clin Biomech (Bristol, Avon).2007; 22(2):176-82.
18. Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011; 20(5):747-55.
19. Björkenheim 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.
20. 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.
21. 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.
22. 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.
23. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010; 19(4):489-94.
24. Konigshausen M, Kubler L, Godry H, Citak M, Schildhauer TA, Seybold D. Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fracture. A reliable system? Injury; 2012; 43(2):223-31.
25. Chodavarapu LM, Chowdojirao SK, Gonu A, Patnala C, Chilakamarri VK. Analysis of surgical fixation of displaced proximal humerus fractures using PHILOS plate. Int J Res Orthop. 2016; 2(4):245-50.
26. Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg. 2013; 22(4):542-9.
27. Giannoudis PV, Xypnitos FN, Dimitriou R, Manidakis N, Hackney R “Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature”. J Orthop Surg Res. 2012; 7(1):39-48.
28. Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008; 90(11):1407-13
29. Grönhagen CM, Abbaszadegan H, Révay SA, Adolphson PY. Medium-term results after primary hemiarthroplasty for comminuted proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg. 2007;16(6):766-73.
30. Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of threeand four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with
a short-term follow-up. J Bone Joint Surg Br. 2007;89(4):516-20.
31. Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PA. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma. 2008; 22(10):698-704.
32. Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br.2010; 92(4):535-9.
The Archives of Bone and Joint Surgery
Volume 7, Issue 1
January and February 2019
Pages 38-45

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History

  • Receive Date: 05 September 2016
  • Revise Date: 11 July 2017
  • Accept Date: 16 October 2017

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