Analysis of Efficacy and Failure in Proximal Humerus Fractures Treated With Locking Plates

Agudelo, Juan; Schürmann, Martin; Stahel, Philip F.; Helwig, Peter; Morgan, Steven J.; Zechel, Wolfgang; Bahrs, Christian; Parekh, Anand A.; Ziran, Bruce H.; Williams, Allison; Smith, Wade R.

doi:10.1097/bot.0b013e31815bb09d

Cited by 350 publications

(292 citation statements)

References 23 publications

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“…Currently, locking plate osteosynthesis has become widely accepted for treatment of periarticular fractures [1,3,9,14,16,17,24,27]. For relatively smaller distal tibia fracture fragments, especially with an average distance of 11 mm from the distal extent of the fracture to the tibial plafond in the current series, a monoaxial locking plate with fixedtrajectory locking screws sometimes may not provide anticipated fixation for the distal fragment [13,20].…”

Section: Discussionmentioning

confidence: 99%

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

Gao

Zhang

Luo

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus.

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Section: Discussionmentioning

confidence: 99%

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

Gao

Zhang

Luo

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Another limitation is that there is some variability in the radiographic measurements we used to evaluate hardware positioning and anatomic alignment. We tried to limit measurement variability by having one person perform all measurements using parameters described in the literature [1,9]. Finally, although we followed patients for a minimum of 1 year, longer duration of followup may have shown a progression toward osteonecrosis in more patients.…”

Section: Discussionmentioning

confidence: 99%

“…Humeral head height was measured as the distance between a line perpendicular to the long axis of the plate at its superior edge and a line perpendicular to the superior edge of the humeral head on an AP radiograph. Anatomic alignment of the fracture was based on the changes in measured head neck-angle as described by Agudelo et al [1] on sequential radiographs. Agudelo et al [1] described the neck-shaft angle as the angle between a line drawn perpendicular to the articular surface and a line through the humeral shaft on an AP radiograph.…”

Section: Methodsmentioning

confidence: 99%

“…Anatomic alignment of the fracture was based on the changes in measured head neck-angle as described by Agudelo et al [1] on sequential radiographs. Agudelo et al [1] described the neck-shaft angle as the angle between a line drawn perpendicular to the articular surface and a line through the humeral shaft on an AP radiograph. The presence of osteonecrosis was determined based on the Ficat classification system modified by Cruess [5].…”

Section: Methodsmentioning

confidence: 99%

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Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Ong

Bechtel

Walsh

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Locking plates have become a commonly used fixation device in the operative treatment of three-and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures. Questions/purposes We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three-and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates. Patients and Methods We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period.

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“…3,4 With the advent of locking plate technology and the development of proximal humerus locking plates, open reduction and internal fixation (ORIF), for the treatment of displaced and unstable proximal humerus fractures, has garnered a great deal of recent clinical attention. [5][6][7][8] Treatment of complex fracture patterns, especially in the elderly individuals, continues to be a challenging and controversial clinical scenario, and there still remains no consensus for the optimal treatment algorithm for these types of fractures. 9 More current data, concerning the use of locking plates in the treatment of proximal humerus fractures, has been very encouraging.…”

Section: Introductionmentioning

confidence: 99%

Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

Grawe

Lee

et al. 2011

Geriatr Orthop Surg Rehabil

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Introduction: Treatment of complex fracture patterns of the proximal humerus continues to be a challenging and controversial clinical scenario. The aim of this study was to report on the outcomes of complex displaced 3-and 4-part fractures of the proximal humerus treated with locked plating and compare the functional results of patients on the basis of age at time of injury. Methods: A retrospective review was completed to identify patients whom had sustained a 3-or 4-part fracture of the proximal humerus (Neer classification), treated surgically with locked compression plating. Patients were recruited for a final follow-up, with clinical (Constant and Disabilities of the Arm, Shoulder, Hand [DASH] scores) and radiographic outcome analysis. Results were compared (t test and Wilcoxon test) with fracture type (3-vs 4-part) and patient age at time of fracture (<65 years vs >65years) as the primary outcome measure. The presence or absence of a complication and presence or absence of a concomitant osseous injury at the time of presentation were evaluated as secondary outcome measures, in regard to overall functional results of the treatment in question. Complications were defined as posttraumatic osteoarthritis, avascular necrosis of the humeral head, and screw cutout with chondrolysis. The null hypothesis being that age of the patient at the time of injury would not greatly affect functional outcome measurements. Results: Forty-five fractures were identified in 45 patients, with 31 three-part fractures and 14 four-part fractures, and 17 patients were available for final follow-up (9 three-part and 8 four-part). Twelve patients were identified as under the age of 65 years and were compared with 5 patients who were identified as older than 65 years of age. The relative Constant score, at final follow-up, for those under the age of 65 was 88.58, while the score for those above the age of 65 was 82.5. In a similar fashion, the DASH score for those younger than 65 was 11.67, while the score for those older than 65 was 12.5. Neither the Constant score nor the DASH score differed in a statistically significant manner, when comparing patients who were younger than 65 to those older than 65 years of age. Conclusion: The current series of fractures was able to demonstrate similar and satisfactory outcomes following locked plating treatment of complex 3-and 4-part proximal humerus fractures in younger patients and patients older than the age of 65, while still accepting the null hypothesis.

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Analysis of Efficacy and Failure in Proximal Humerus Fractures Treated With Locking Plates

Cited by 350 publications

References 23 publications

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

Three- and Four-part Fractures Have Poorer Function Than One-part Proximal Humerus Fractures

Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus

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