Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail

Lorenz, Greta; Schönthaler, Wolfgang; Huf, Wolfgang; Komjati, Micha; Fialka, Christian; Boesmueller, Sandra

doi:10.1007/s00068-020-01380-7

Cited by 18 publications

(12 citation statements)

References 66 publications

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“…The complication rate was 20.7% (6/29) in the varus group, 12.7% (9/71) in the normal group, and 12.9% (4/31) in the valgus group, with the varus group showing a significantly higher complication rate compared to the other two groups ( P < 0.05). Published literature has reported complication rates of 10%–36% after the treatment of proximal humerus fractures with locking plates and 12%–59% after intramedullary nails 18,19 . The complication rate found in our study is relatively low, probably because our cohort was relatively young, had generally good bone stock, and 2‐part proximal humerus fractures accounted for nearly 1/3 of the cases.…”

Section: Discussionmentioning

confidence: 45%

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Dai

Xiang

Zhang

et al. 2023

Orthopaedic Surgery

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ObjectiveThere is currently no consensus on proximal humerus fractures with an initial deformity in the coronal plane who are better off with plates or nails, so we designed this study. To compare the effect of the initial deformity in the coronal plane of proximal humerus fractures on postoperative outcomes, we compare the maintenance of reduction in procedures utilizing plates and nails, and analyzed the subsequent occurrence of complications to explore whether the initial deformity should dictate the fixation approach.MethodsThe clinical data of patients with proximal humerus fractures who were hospitalized and underwent surgical treatment in our hospital from January 2016 to December 2020 were reviewed. Postoperative functional scores (American Shoulder and Elbow Surgeons, ASES; Constant‐Murley Score, CMS), Neck‐shaft angle (NSA), Quality of fracture reduction, Deltoid Tuberosity Index (DTI), and complications were compared among cases with initial varus, normal, or valgus deformities.ResultsWe included 131 patients, 56 males and 75 females, with a mean age of 60.89 ± 5.53 years (range 50–76) and a mean follow‐up duration of 16.63 ± 6.78 months (range 12–48). Of these, 29 cases had initial varus displacement, 71 had a normal NSA, and 31 had initial valgus displacement. Seventy‐five were treated with a locking plate and 56 with a nail. After open reduction and internal fixation, the NSA was restored to normal (−135°) in all patients in all groups (P > 0.05). There was a significant difference in NSA changes at the last follow‐up; 2.93° ± 2.12° in the varus group, 1.77° ± 1.18° in the normal group, and 2.32° ± 1.64° in the valgus group, with the highest change occurring in the varus group. There was no significant difference in the range of motion or functional scores including ASES and CMS among the three groups (P > 0.05). The complication rate of 20.7% in the varus group was significantly higher than the complication rates of 12.7% in the normal and 12.9% in the valgus groups (P < 0.05).ConclusionsWhile proximal humerus fractures with initial coronal displacement (varus, normal, and valgus) show similar postoperative functional outcomes, varus fractures have a higher rate of complications. The nail provides better maintenance of reduction than the locking plate, especially in varus fractures.

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Section: Discussionmentioning

confidence: 45%

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Dai

Xiang

Zhang

et al. 2023

Orthopaedic Surgery

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“…In a recent comparative, multicenter, retrospective study, 5 it was observed that if the medial hinge is preserved, locking plate is recommended; in other cases, both devices can be used. In 2019, Lorenz et al 13 stated that just hundred half of the patients with three-four part fractures treated with these devices suffered at least one complication (screw perforation; nonunion and avascular necrosis). Recently, Gumina et al 7 proposed to fix a reduced (through a mini open delto-pectoral approach e 2 cm) three-part humeral head fracture using, for 45 days, BTWs, percutaneously inserted in such a way as to always obtain the same isostatic construct.…”

Section: Discussionmentioning

confidence: 99%

“…Locking plates and intramedullary nail are the most commonly used devices for the fixation of three-part humeral head fractures, each of which should be used depending on the characteristics of the fracture (integrity of the medial hinge and of the lateral and medial columns), patient age, and osteoporosis degree. 5,11,13 Literature data indicate that the use of these fixation systems involves a percentage of major complications (avascular necrosis, nonunion, and sintering) that ranges from 9% to 40%. 4,6,11,15,18 Recently, fixation of complex three-part humeral head fractures through a system of blocked threaded wires (BTWs) and a mini (2.5 cm) deltopectoral approach has been reported to lead to similar clinical and radiological outcomes with respect to locking plate and nail, 7 but major complication rate was quite lower.…”

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confidence: 99%

Three-Part Humeral Head Fractures Treated With A Definite Construct Of Blocked Threaded Wires: Finite Element And Parametric Optimization Analysis

Gumina

Carbone

Cantore

et al. 2022

Journal of Shoulder and Elbow Surgery

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“…In a recent comparative, multicenter, retrospective study, 5 it was observed that if the medial hinge is preserved, locking plate is recommended; in other cases, both devices can be used. In 2019, Lorenz et al 13 stated that just hundred half of the patients with three-four part fractures treated with these devices suffered at least one complication (screw perforation; nonunion and avascular necrosis). Recently, Gumina et al 7 proposed to fix a reduced (through a mini open delto-pectoral approach – 2 cm) three-part humeral head fracture using, for 45 days, BTWs, percutaneously inserted in such a way as to always obtain the same isostatic construct.…”

Section: Discussionmentioning

confidence: 99%

Three-part humeral head fractures treated with a definite construct of blocked threaded wires: finite element and parametric optimization analysis

Gumina¹,

Candela²,

Cacciarelli³

et al. 2021

JSES International

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Background Mini open reduction and percutaneous fixation of three-part humeral head fracture with blocked threaded wires has demonstrated functional results similar to locking plates or intramedullary nails but with significantly lower major complication rate. In the context of three-part humeral head fractures, we performed a parametric optimization through a finite element analysis of a recently published construct to verify if the encouraging clinical results can be supported by a more rigorous investigation from a mechanical viewpoint. Materials and Methods The 2-dimensional geometry of a three-part proximal humerus fracture synthetized with a system of blocked threaded wires was created. Tension/bending/shear and compression load tests were simulated. A parametric optimization analysis was performed considering four design parameters (height of wire couples; wire material; interdistance between two wires). Eighteen simulations were carried out. Additional analyses were performed also considering a varying diameter of the external rod. Results Four points where the largest gap occurs and three points associated with the highest stress concentration were considered. As per the tension/bending/shear loading, a slight gap increase was observed in two different points (8.494 μm; 7.540 μm), while a slight decrease was detected along the greater tuberosity fracture line (1.445 μm). The maximum von Mises stress up to 64.4 MPa was achieved in the humeral head. As per the compression loading, the gap increased along the greater tuberosity fracture line (1.445 μm; 7.545μm); the maximum von Mises stress attains the value of 64.42 MPa. The smallest gap distance (15.37μm) and the lowest von Mises stress (51.51 MPa) were obtained in two different alternative constructs. The diameter of the external rod had no significant effect. Conclusions The studied construct is biomechanically valid; it only allows micromovements (one-thousandth of the characteristic humerus size) that are not able to cause humeral head rotation and translation. Furthermore, the construct generates acceptable pressure stresses on sensible areas of the fractured humeral head. Compared to the original construct, we propose to space the pair of horizontal wires for the great tuberosity by at least 1 cm.

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Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail

Cited by 18 publications

References 66 publications

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures

Three-Part Humeral Head Fractures Treated With A Definite Construct Of Blocked Threaded Wires: Finite Element And Parametric Optimization Analysis

Three-part humeral head fractures treated with a definite construct of blocked threaded wires: finite element and parametric optimization analysis

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