Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients

Abstract

BackgroundTo evaluate the treatment efficacy and complications of the lateral minimally invasive plate osteosynthesis (MIPO) method in geriatric patients with a humerus diaphyseal fracture with proximal extension.Patients and methodsThe study included a total of 21 patients (18 females, 3 males; mean age 74±6.3 years, range 65–89 years) who underwent surgery with the lateral MIPO technique for a humerus diaphyseal fracture with proximal extension during the period January 2011 to December 2016. None of the patients had additional injuries and all completed regular follow-up. According to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation classification system, the fractures were evaluated as 12C1 in 17 cases and 12C3 in 4 cases. All patients were evaluated radiologically and functionally at 6 months and 1 year. In the follow-up evaluations, the Constant–Murley score and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score were used.ResultsNo non-union, avascular necrosis or infection was seen in any patient. The mean time to union was 15.7 weeks. Impingement syndrome was seen in 2 patients and radial nerve palsy in 2 patients. The mean Constant–Murley score was 70.6±10.2 at 6 months and 84±7.6 at the end of 1 year. The mean Q-DASH score was 38.6±15.1 at 6 months and 21.9±13.1 at the end of 1 year. The increase in the Constant–Murley scores from 6 months to 1 year was statistically significant (p<0.0001). The decrease in the Q-DASH scores between 6 months and 1 year was determined to be statistically significant. In the 2 patients with radial nerve palsy, the functions were seen to completely recover during follow-up. No axillary nerve palsy was seen in any patient.ConclusionMetadiaphyseal humerus fractures with proximal extension in the elderly can be successfully treated with the lateral MIPO technique. When applied correctly, it is a method with high rates of union and low rates of complications.

Arthroplasty as Primary Treatment for Metadiaphyseal Proximal Humerus Fractures: A Viable Alternative to Osteosynthesis for the Elderly

“…Some authors have advocated fixation with complete open or minimally invasive locked plating. [26][27][28] ORIF of proximal humerus fractures in this patient population is associated with higher levels of technical difficulty, 26 outcomes that are operator dependent, 26 the possibility of subacromial impingement syndrome due to hardware prominence, 7 risk of axillary and radial nerve palsies, 28 and a two-to threefold increased risk of all complications when compared to younger patients. 40 Robinson et al presented the large series of patients treated with ORIF and found overall nonunion rate of 7%.…”

“… 4 , 6 , 25 Moreover, ORIF does not address the common concomitant issues of glenohumeral arthritis and rotator cuff pathology, which can be found with geriatric proximal humerus fractures. 26 – 28 Utilizing magnetic resonance imaging analysis of proximal humerus fractures, rates of rotator cuff tears from 42% to 70% has been demonstrated, which can be associated with limited functional outcomes. 29 , 30 As a result, the current operative approach to complex proximal humerus fractures in this population has shifted largely towards RTSA utilization, with increasing literature support.…”

A New Surgical Technique and Clinical Outcomes of Operated Proximal Metadiaphyseal Humeral Fractures and Nonunions With the Use of Reversed Anatomic Distal Femoral Locking Plate

“…Both nailing and plating techniques have been described so far for the treatment of displaced proximal metadiaphyseal humerus fractures with reasonable results [1][2][3]6,17]. Although minimally invasive approaches can be applied using indirect methods for fracture reduction, a single extensile approach is usually necessary [1].…”

“…They mainly occur in osteoporotic bone exhibiting a bending wedge or a long spiral type with or without a large butterfly fragment [1]. A range of treatment options have been described for these fractures, ranging from nonoperative management to internal fixation techniques, including intramedullary nailing and plate fixation [1][2][3][4][5][6][7]. However, these fractures are too high for humeral bracing and adequate stability is difficult to be maintained.…”

Minimally invasive plate osteosynthesis for segmental humerus fractures with a helical plate. Which distal fixation—the anterior or lateral—is superior?

“…However, fixation of proximal and distal fractures is not possible with the anterior opening MIPO technique. For this purpose, it has been reported in a limited number of studies that extended segment fractures could be treated by using the anatomical PHILOS plate (2,8,9). Hence, it is possible to protect the deltoid insertion, to use the distal anterior surface for fixation of the distal screws, and to move away from the radial nerve zone by applying PHILOS plates that are helically shaped manually.…”