Intramedullary Plating of Complex Proximal Humerus Fractures: A Case Series

Document Type : RESEARCH PAPER

Authors

Dept of Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, Scotland

Abstract

Objectives: To assess fracture union rates using novel intramedullary plate technique. Post-operative 
humeral neck-shaft angles, patient range of motion and complication profile were secondary outcomes 
of interest.
Methods: Single surgeon, retrospective case series of surgical technique at major trauma centre in Scotland. A 
2.0mm mini-fragment plate was secured to the humeral head to act as an intramedullary strut during fixation in 
complex proximal humerus fractures. Fracture union and neck-shaft angle were assessed radiologically, whilst 
range of motion and complication profiles were assessed clinically.
Results: Twelve patients were followed up for an average of 10 months post-operatively. All achieved bony union 
with a mean neck-shaft angle of 128°. Mean range of motion values were 100° forward elevation, 83° abduction, 
60° internal rotation and 37° external rotation. Four patients required further surgical intervention- two for hardware 
prominence, one for adhesive capsulitis and one for subsequent rotator cuff failure. There were no cases of 
avascular necrosis or infection.
Conclusion: This novel technique addresses the established biomechanical propensity of proximal humerus 
fractures to fail in varus collapse and screw cut-out. This method provides an alternative to arthroplasty in the most 
severe proximal humerus fractures and is readily adopted via standard orthopaedic kit.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6):1077-1089.
  2. Handoll H, Brealey S, Rangan A, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial – a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess (Rockv). 2015; 19(24):1-280. doi:10.3310/hta19240
  3. Oldrini LM, Feltri P, Albanese J, Marbach F, Filardo G, Candrian C. PHILOS Synthesis for Proximal Humerus Fractures Has High Complications and Reintervention Rates: A Systematic Review and Meta-Analysis. Life (Basel). 2022; 12(2):311. doi:10.3390/life12020311.
  4. McMillan TE, Johnstone AJ. Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions. Int Orthop. 2018; 42(8):1935-1942. doi:10.1007/s00264-017-3652-6.
  5. Jung WB, Moon ES, Kim SK, Kovacevic D, Kim MS. Does medial

 

support decrease major complications of unstable proximal humerus fractures treated with locking plate? BMC Musculoskelet Disord. 2013;14(1):102. doi:10.1186/1471-2474-14-102.

  1. Katthagen JC, Schwarze M, Meyer-Kobbe J, Voigt C, Hurschler C, Lill H. Biomechanical effects of calcar screws and bone block augmentation on medial support in locked plating of proximal humeral fractures. Clinical Biomechanics. 2014; 29(7):735-741. doi: 10.3390/life12020311.
  2. 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):185-191. doi:10.1097/BOT.0b013e3180333094.
  3. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect Medial Reduction and Strut Support of Proximal Humerus Fractures Using an Endosteal Implant. J Orthop Trauma. 2008; 22(3):195-200. doi:10.1097/BOT.0b013e31815b3922.
  4. Doorenbosch CAM, Harlaar J, Veeger DHEJ. The globe system: an unambiguous description of shoulder positions in daily life movements. J Rehabil Res Dev. 2003; 40(2):147-155.
  5. Paavolainen P, Björkenheim JM, Slätis P, Paukku P. Operative Treatment of Severe Proximal Humeral Fractures. Acta Orthop Scand. 1983; 54(3):374-379. doi:10.3109/17453678308996587.
  6. Frangen T, Dudda M, Martin D, et al. Operative und klinische Erfahrungen mit winkelstabilen Implantaten bei proximalen Humerusfrakturen - Wirklich alles besser? Zentralbl Chir. 2007; 132(1):60-69. doi:10.1055/s-2006-958639.
  7. 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; 430:176-181. doi:10.1097/01.blo.0000137554.91189.a9.
  8. Schöbel T, Schleifenbaum S, Nitsch V, Hepp P, Theopold J. Primary stability of cement augmentation in locking plate fixation for proximal humeral fractures: A comparison of absorbable versus non-absorbable cement. Clin Biomech (Bristol, Avon). 2022; 91:105516. doi:10.1016/j.clinbiomech.2021.105516.
  9. Warnhoff M, Jensen G, Dey Hazra RO, Theruvath P, Lill H, Ellwein A. Double plating - surgical technique and good clinical results in complex and highly unstable proximal humeral fractures. Injury. 2021; 52(8):2285-2291. doi:10.1016/j.injury.2021.05.047.
  10. Park SG, Ko YJ. Medial Buttress Plating for Humerus Fractures with Unstable Medial Column. J Orthop Trauma. 2019; 33(9):e352-e359. doi:10.1097/BOT.0000000000001515.
  11. 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):427-433. doi:10.1016/j.jse.2004.01.034.
  12. Plecko M, Kraus A. Die winkelstabile Plattenosteosynthese bei Frakturen am proximalen Humerus mit der LPHP (Locking Proximal Humerus Plate). Oper Orthop Traumatol. 2005; 17(1):25-50. doi:10.1007/s00064-005-1120-8.
  13. 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):1689-1697. doi:10.2106/JBJS.H.00133.
  14. Gerber C, Werner CML, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86-B(6):848-855. doi:10.1302/0301-620X.86B6.14577.
  15. Mighell MA, Kolm GP, Collinge CA, Frankle MA. Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elbow Surg. 2003; 12(6):569-577. doi:10.1016/s1058-2746(03)00213-1.
  16. Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty. J Bone Joint Surg Br. 2008; 90-B (11):1407-1413. doi:10.1302/0301-620X.90B11.21070.

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 6
June 2024
Pages 407-411

Files

History

  • Receive Date: 13 August 2023
  • Revise Date: 27 March 2024
  • Accept Date: 02 April 2024

Share

How to cite

Statistics