Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

Südkamp, Norbert P.; Bayer, Jörg; Hepp, Pierre; Voigt, C.; Oestern, H.-J.; Kääb, Max J.; Luo, Congfeng; Plecko, Michael; Wendt, Klaus W.; Köstler, Wolfgang J.; Konrad, G.

doi:10.2106/jbjs.h.00006

Cited by 517 publications

(443 citation statements)

References 29 publications

(44 reference statements)

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“…As mentioned, maybe in a larger collective of patients, significant differences could be revealed. The overall rate for complications after internal fixation of proximal humeral head fractures is documented in the actual literature as between 10% and 34% [1,2,7,8,11,13,17,19,20,22]. The small rate of complications in our study (14% deltoid split; 13% deltopectoral) may be explained by the fact that three experienced surgeons performed the osteosynthesis.…”

Section: Discussionmentioning

confidence: 50%

See 1 more Smart Citation

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society. The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated. Questions/purposes In this prospective randomized study, we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to (1) complication rate; (2) shoulder function (Constant score); and (3) pain (visual analog scale [VAS]) for internal fixation of displaced humeral fractures with a polyaxial locking plate.Methods We randomized 120 patients with proximal humeral fractures to receive one of these two approaches (60 patients for each approach). We prospectively documented demographic and perioperative data (sex, age, fracture type, hospital stay, operation time, and fluoroscopy time) as well as complications. Followup examinations were conducted at 6 weeks, 6 months, and 12 months postoperatively, including radiological and clinical evaluations (Constant score, activities of daily living, and pain [VAS]). Baseline and perioperative data were comparable for both approaches. The sample size was chosen to provide 80% power, but it reached only 68% as a result of the loss of followups to detect a 10-point difference on the Constant score, which we considered the minimum clinically important difference. Results Complications or reoperations between the approaches were not different. Eight patients in the deltoid-split group (14%) needed surgical revisions compared with seven patients in the deltopectoral group (13%; p = 1.00). Deltoid-split and deltopectoral approaches showed similar Constant scores 12 months postoperatively (Deltoid-split 81; 95% confidence interval [CI], 74-87 versus deltopectoral 73; 95% CI, 64-81; p = 0.13), and there were no differences between the groups in terms of pain at 1 year (deltoid-split 1.8; 95% CI, 1.2-1.4 versus deltopectoral 2.5; 95% CI, 1.7-3.2; p = 0.14). No learning-curve effects were noted; fluoroscopy use during surgery and function and pain scores during followups were similar among the first 30 patients and the next 30 patients treated in each group. Conclusions The treatment of proximal humeral fractures with a polyaxial locking plate is reliable using both approaches. For a definitive recommendation for one of these approaches, further studies with appropriate sample size are necessary.

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Section: Discussionmentioning

confidence: 50%

“…The ADLs at 6 weeks postoperatively were similar and increased for all groups over time ( Table 4). The average ADL reached 18 (95% CI, [17][18][19][20] for the deltoid-split and 17 (95% CI, [14][15][16][17][18][19] for the deltopectoral group 12 month after operation (p = 0.31).…”

Section: Functionmentioning

confidence: 99%

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Buecking

Mohr

Bockmann

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Because the results of humeral head replacement for proximal humeral fractures have been so unpredictable, it is critical that the results of osteosynthesis for these fractures be improved. Previous reports of locking plates used for proximal humeral fractures cite overall complications rates between 10% and 34% [2,7,8,13,15,16]. Research initiatives must focus on lowering these complication rates.…”

Section: How Do We Get There?mentioning

confidence: 99%

CORR Insights®: Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Duralde

2014

Clinical Orthopaedics &Amp; Related Research

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“…So fanden Acklin et al [1] im 1-Jahres-Follow-up nach plattenosteosynthetischer Versorgung einer proximalen Humeruskopffraktur einen mittleren Constant-Score von 75±11 Punkten (91% der Gegenschulter). In anderen Untersuchungen wurden im 1-Jahres-Follow-up relative Constant-Score-Werte von 85,1-87% angegeben [14,61].…”

Section: Plattenosteosyntheseunclassified

Frakturen des Humeruskopfs

Imrecke

Katthagen

Voigt

et al. 2014

Trauma Berufskrankh

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Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

Cited by 517 publications

References 29 publications

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

CORR Insights®: Deltoid-split or Deltopectoral Approaches for the Treatment of Displaced Proximal Humeral Fractures?

Frakturen des Humeruskopfs

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