A new low-profile anatomic locking plate for fixation of comminuted, displaced greater tuberosity fractures of the proximal humerus

Abstract

Background: Although various implants exist for the fixation of isolated greater tuberosity fractures, few implants are specifically designed for such fractures. The purpose of this study was to investigate the clinical and radiologic outcomes of open reduction-internal fixation with a low-profile anatomic locking plate for comminuted greater tuberosity fractures of the proximal humerus. Methods: From November 2012 to February 2018, 24 patients with displaced and comminuted isolated greater tuberosity fractures were treated with the new low-profile anatomic locking plate. To determine clinical outcomes, we evaluated active range of motion; the visual analog scale pain score; the Constant-Murley score; the Disabilities of the Arm, Shoulder and Hand score; radiographs; and complications. Results: In all cases, a mean follow-up period of 29.3 months (range, 18-48 months) was completed. All patients achieved bone union with a mean healing time of 11.3 weeks (range, 8-16 weeks). The mean Constant-Murley score was 91.1 points (range, 69-100 points), with a rate of good to excellent results of 95.8%. The average Disabilities of the Arm, Shoulder and Hand score was 9.9 points (range, 2-25 points), and the mean visual analog scale pain score was 1.1 points (range, 0-4 points). Mean active forward flexion, abduction, external rotation, and internal rotation (level) were 157 , 152 , and 40 , and T11, respectively. Postoperatively, 1 patient had persistent shoulder stiffness, and 1 patient had recurrence of shoulder dislocation because of a falling injury during badminton. No serious complications such as subacromial impingement, malunion, nonunion, loss of reduction, or implant failure occurred. Conclusions: The new low-profile anatomic locking plate was useful for the treatment of comminuted isolated greater tuberosity fractures as it provided reliable stability and satisfactory radiographic and functional results. The described technique is a simple and effective method and provides a new reliable option for the treatment of isolated greater tuberosity fractures.

Efficacy of Intramedullary Nailing in the Treatment of Comminuted Proximal Humeral Fractures and Its Influence on Shoulder Joint Function Recovery

“…It is shown that the elderly are at greater risk of CPHFs in response to slightly larger external stimuli, while young adults often suffer from proximal humeral comminuted fractures under a stronger violent stimulus [ 4 ]. Without timely and effective treatment and intervention, the disease may seriously affect the patient's shoulder joint function, bringing varying degrees of pain and discomfort to patients and even leading to heavy medical pressure on the patient's family and society [ 5 , 6 ]. Therefore, if a clinical treatment strategy with low pain and effective repair of shoulder joint function can be found, it will greatly contribute to the treatment of CPHFs.…”

A new biomechanical classification system for split fractures of the humeral greater tuberosity: guidelines for surgical treatment

“…(iii) Type III (multi-fragment) fractures should be fixed using a suture bridge or small locking plate to provide stable fixation and early return to function. This surgical technique is simple and efficient [26][27][28]. (iv) Type IV (multi-fragment with medium size RCT) fractures should be fixed using a small locking plate augmented with suture anchors via a mini-open deltoid-split approach [13,16,23,24,29].…”

Arthroscopic Assisted Versus Open Reduction and Internal Fixation of Greater Tuberosity Fractures of the Proximal Humerus

“…Open reduction and internal fixation with locking plates combined or not with suture reinforcement are described as a very useful technique for the treatment of greater tuberosity fractures, especially in osteoporotic bone with big fragments [18,19]. Open plate osteosynthesis provides accurate reduction under direct visualization, rigid fixation of the avulsed fragment, and early mobilization facilitating good functional outcomes, decreasing the possibility of reduction loosening and secondary displacement [20]. The preferred approach for plate fixation is the deltopectoral approach but recent studies have shown promising results with shorter plates that need smaller incisions for placement [14,20].…”

“…Open plate osteosynthesis provides accurate reduction under direct visualization, rigid fixation of the avulsed fragment, and early mobilization facilitating good functional outcomes, decreasing the possibility of reduction loosening and secondary displacement [20]. The preferred approach for plate fixation is the deltopectoral approach but recent studies have shown promising results with shorter plates that need smaller incisions for placement [14,20]. This lower profile plates, not specific for this greater tuberosity fractures, have been described to avoid or reduce the complication associated with classic plates and maintaining the rates of union and functional recovery [20].…”

“…The preferred approach for plate fixation is the deltopectoral approach but recent studies have shown promising results with shorter plates that need smaller incisions for placement [14,20]. This lower profile plates, not specific for this greater tuberosity fractures, have been described to avoid or reduce the complication associated with classic plates and maintaining the rates of union and functional recovery [20]. For these techniques, the use of an anterolateral approach has demonstrated non-inferior outcomes with less complications [21].…”