Intramedullary Plating of Complex Proximal Humerus Fractures: A Case Series - Letter to Editor

Document Type : LETTER TO THE EDITOR

Authors

Department of Shoulder and Elbow Surgery, Center for Orthopedic Surgery, the Third Affiliated Hospital of Southern Medical University, China

10.22038/abjs.2024.81804.3727

Abstract

Abstract: We commend McDonald et al. for their innovative technique using intramedullary plating for complex proximal humerus fractures, particularly addressing the challenge of calcar comminution. Our approach, using an anterior deltoid split, contrasts with the deltopectoral method, offering enhanced lateral exposure and minimizing vascular disruption, thus facilitating fracture reduction. The displaced tuberosities allow for direct visualization, enabling secure intramedullary plate placement. Emphasizing robust humeral head support, we advocate for both proximal and distal plate fixation to maintain the neck-shaft angle during early rehabilitation. In elderly or osteoporotic patients, combining an intramedullary plate with allograft bone grafting significantly improves fracture stability and union rates, aligning with established biomechanical principles. This approach, supported by previous studies, underscores the efficacy of comprehensive fixation strategies in managing complex proximal humerus fractures.

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References

  1. Donald SM, Yoong A, Skrzypiec P, Johnstone A. Intramedullary Plating of Complex Proximal Humerus Fractures: A Case Series. Arch Bone Jt Surg. 2024; 12(6):407-411. doi:10.22038/abjs.2024.74258.3437.
  2. Wang Y, Zhao L, Liu C, Qin K. Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach. Indian J Orthop. 2024;58(4):362-370. doi:10.1007/s43465-024-01098-3.
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  1. Bhayana H, Chouhan DK, Aggarwal S, et al. Outcomes of plate osteosynthesis for displaced 3-part and 4-part proximal humerus fractures with deltopectoral vs. deltoid split approach. Eur J Trauma Emerg Surg.2022; 48(6):4559-4567. doi:10.1007/s00068-021-01761-6.
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  3. Chow RM, Begum F, Beaupre LA, Carey JP, Adeeb S, Bouliane MJ. Proximal humeral fracture fixation: locking plate construct ± intramedullary fibular allograft. J Shoulder Elbow Surg. 2012; 21(7):894-901. doi:10.1016/j.jse.2011.04.015.

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 12
December 2024
Pages 874-875

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History

  • Receive Date: 24 August 2024
  • Revise Date: 27 November 2024
  • Accept Date: 07 September 2024

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