Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate: Results of a Prospective, Multicenter, Observational Study

Südkamp, N.; Bayer, J.; Hepp, P.; Voigt, C.; Oestern, H.; Kääb, M.; Luo, C.; Plecko, M.; Wendt, K.; Köstler, W.; Konrad, G.
June 2009
Journal of Bone & Joint Surgery, American Volume;Jun2009, Vol. 91-A Issue 6, p1320
Academic Journal
Background: The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate. Methods: One hundred and eighty-seven patients (mean age, 62.9 ± 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six- month, and one-year follow-up examinations, 165(88%), 158 (84%), and 155(83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up. Results: Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 ± 13.7 points, corresponding to 85.1% ± 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 ± 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-yearfollow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture. Conclusions: Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.


Related Articles

  • TREATMENT OF MULTIDIRECTIONALLY UNSTABLE SUPRACONDYLAR HUMERAL FRACTURES IN CHILDREN. Leitch, K. K.; Kay, R. M.; Femino, J. D.; Tolo, V. T.; Storer, S. K.; Skaggs, D. L. // Journal of Bone & Joint Surgery, American Volume;May2006, Vol. 88-A Issue 5, p980 

    Background: There is an uncommon subset of supracondylar humeral fractures in children that are so unstable they can displace into both flexion and extension. The purposes of this study were to describe this subset of supracondylar fractures and to report a new technique of closed reduction and...

  • Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients. Sosef, Nico; van Leerdam, Roderick; Ott, Pieter; Meylaerts, Sven; Rhemrev, Steven // Archives of Orthopaedic & Trauma Surgery;May2010, Vol. 130 Issue 5, p605 

    To report on the results of a minimally invasive technique for the fixation of displaced proximal humeral fractures with a locked intramedullary nail. All consecutive patients treated with a T2â„¢ intramedullary nail between 2004 and 2007 were evaluated. Thirty-three patients were included...

  • A Case Of Midshaft Humerus Nonunion In A 36 Year Old Intellectually Disabled Man. Maor, Dror; Khoury, Amal; Mosheiff, Rami // Internet Journal of Orthopedic Surgery;2011, Vol. 18 Issue 2, p1 

    A 36 year old intellectually disabled fully dependent, right hand dominant man sustained an isolated humeral shaft fracture following an assault.. Initial non-operative management failed with the result of non-union of the humerus. An attempt at plate fixation also failed. He was thus assessed...

  • Does the technique of lateral cross-wiring (Dorgan's technique) reduce iatrogenic ulnar nerve injury? Memisoglu, Kaya; Kesemenli, Cumhur Cevdet; Atmaca, Halil // International Orthopaedics;Mar2011, Vol. 35 Issue 3, p375 

    In this study we compared the results of patients with displaced supracondylar humeral fractures who had been treated with all lateral cross-wire and medio-lateral cross-wire fixation techniques. Only the 139 patients who were able to attend the final examination were included in the assessment....

  • Treatment of proximal humerus fracture using multiple intramedullary flexible nails. Wachtl, S. W.; Marti, C. B.; Hoogewoud, H. M.; Jakob, R. P.; Gautier, E. // Archives of Orthopaedic & Trauma Surgery;Mar2000, Vol. 120 Issue 3/4, p171 

    A total of 61 patients with a proximal humeral fracture was treated between January 1996 and March 1998 by closed reduction and fracture fixation with intramedullary Prévot (or Nancy) nails. Of these, 28 female and 25 male patients with a mean age of 52 years (range 3–¶91 years)...

  • Anterior plating as a surgical alternative in the treatment of humeral shaft non-union. Livani, Bruno; Belangero, William; Medina, Giovanna; Pimenta, Ciro; Zogaib, Rodrigo; Mongon, Mauricio // International Orthopaedics;Oct2010, Vol. 34 Issue 7, p1025 

    This study included 15 patients with humeral shaft fractures who had no clinical, radiological or bone scan signs of healing after eight months. The patients were followed for a mean of 35.8 months. No patient was lost to follow-up. Anterior plating of humeral shaft nonunion via an anterior...

  • PHILOS humerus plate for a distal tibial fracture. Twaij, Haider; Damany, Dev // Journal of Surgical Case Reports;Jan2013, Vol. 2013 Issue 1, Special section p1 

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required...

  • Management of supracondylar fracture of humerus with JESS in adults. Ghosh, Soumya; Patar, Mrityunjoy; Chaudhuri, Arunima; Datta, Soma; Banerjee, Debabrata; Mitra, Utpal Kumar // Journal of the Scientific Society;Jan-Apr2015, Vol. 42 Issue 1, p16 

    As life expectancy increases overall incidence of distal humeral fractures is increasing worldwide. Objectives: To evaluate the results of JESS External fixator in the management of supracondylar fracture with or without intercondylar extension in adults. Materials and Methods: This prospective...

  • Medial and Lateral Percutaneous Fixation versus Lateral Fixation for Treatment of Gartland Type II, III Supracondylar Fracture of Humerus in Children. Sadik, Diaa G. // Iraqi Journal of Medical Sciences;2015, Vol. 13 Issue 2, p183 

    Background Operative treatment of supracondylar fractures with reduction and percutaneous pinning is so effective and safe. The great majority of displaced fractures should be treated operatively. There is little controversy that all closed Gartland type II and III fractures should have an...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics