Open Reduction and Internal Fixation of Proximal Humerus Fractures with a Cannulated Blade Plate

Abstract

ObjectiveInternal fixation of proximal humerus fractures with an implant assuring rotational and angular stability to restore form and function of the glenohumeral joint. IndicationsProximal humerus fractures: two-and three-part fractures, meta-and diaphyseal fractures of the proximal second fifth. ContraindicationsComminuted fractures of the humeral head. Proximal humerus fractures in children. Surgical TechniqueAnterior approach. Blunt dissection of the deltopectoral interval, retracting the cephalic vein medially. Judicious exposure of the fracture site and reduction of the fracture. A 90° blade plate opened up to 110-120° is inserted from anterolateral immediately proximal to or through the subcapital fracture gap. The blade of the blade plate is introduced into the proximal half of the humeral head. In the presence of an avulsion of the greater tuberosity, a wire cerclage is added. ResultsBetween June 1998 and December 1999, we treated 20 patients (eight men, twelve women, age 65-92 years) and assessed them prospectively. All fractures were closed (AO types 11-A3 n = 8, 11-B1 n = 5, 11-B2 n = 3, 11-B3 n = 1, and 11-C2 n = 3). Loosening of plates was seen in three patients and a blade perforation in one, all requiring a revision (revision with plate blade twice, shoulder hemiarthroplasty once, early implant removal once). Five patients passed away, and two were too old to undergo a follow-up examination. The Constant score in 13 patients performed after 8 (7-10) months reached 62/100 (opposite shoulder 92/100). This corresponds to a satisfactory outcome.

Internal Fixation of Unstable Proximal Humerus Fractures With an Anatomically Preshaped Interlocking Plate: A Clinical and Radiologic Evaluation

“…39,40 Clinical series to investigate the first-generation socalled fixed-angle stabilization systems, e.g., blade or fixator plates, revealed a high rate of unsatisfactory results, with a rate of blade penetration of up to 30% or loss of fracture reduction in up to 50% of elderly patients. 33,35,41 Joint replacement may help to avoid these complications but is more expensive and is associated with other problems (e.g., rotator cuff reconstruction) that produce only moderately good outcomes. 9,30,42 This prospective study evaluated the routine clinical use of a new stabilization technique with an anatomically preshaped plate, i.e., an internal fixator that offers the possibility of three-dimensional interlocking screw anchorage in the humeral head.…”

“…For example, conventional plate osteosynthesis is described as having a loss of reduction rate of up to 20%. [32][33][34][35] Minimally invasive stabilization techniques aim to preserve vascularity of the humeral head and to avoid additional tissue damage to minimize the risk of nonunion or avascular head necrosis.…”

Biomechanical comparison of screw-based zones of a spatial subchondral support plate for proximal humerus fractures

“…We were unable to find any study in the literature directly investigating this question. Perhaps, the closest study was that by Fuchs et al 28 where a 90° blade plate was straightened to 110°–120° and satisfactory clinical outcomes were achieved. Their motive for this change in the angle was to move the blade’s entry point to a more distal location so that the subacromial impingement can be avoided and also to allow the blade to enter the central, high-cancellous-bone-density region of the humeral head.…”