The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Intramedullary Plating of Complex Proximal Humerus Fractures: A Case Series

Document Type : RESEARCH PAPER

Authors
Stephen Mc. Donald
Andrel Yoong
Piotr Skrzypiec
Alan Johnstone
Dept of Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, Scotland
10.22038/abjs.2024.74258.3437
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
Calcar
Complex
Proximal humeral fracture
Varus collapse
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 6
June 2024
Pages 407-411

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