Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate Philos™ vs. proximal humerus nail MultiLoc®

Abstract

BackgroundProximal humeral fractures are with an incidence of 4–5 % the third most common fractures in the elderly. In 20 % of humeral fractures there is an indication for surgical treatment according to the modified Neer-Criteria. A secondary varus dislocation of the head fragment and cutting-out are the most common complications of angle stable locking plates in AO11-A3 fractures of the elderly. One possibility to increase the stability of the screw-bone-interface is the cement augmentation of the screw tips. A second is the use of a multiplanar angle stablentramedullary nail that might provide better biomechanical properties after fixation of 2-part-fractures. A comparison of these two treatment options augmented locking plate versus multiplanar angle stable locking nail in 2-part surgical neck fractures of the proximal humerus has not been carried out up to now.Methods/DesignForty patients (female/male, ≥60 years or female postmenopausal) with a 2-part-fracture of the proximal humerus (AO type 11-A3) will be randomized to either to augmented plate fixation group (PhilosAugment) or to multiplanar intramedullary nail group (MultiLoc). Outcome parameters are Disabilities of the Shoulder, Arm and Hand-Score (DASH) Constant Score (CS), American Shoulder and Elbow Score (ASES), Oxford Shoulder Score (OSS), Range of motion (ROM) and Short Form 36 (SF-36) after 3 weeks, 6 weeks, 3 months, 6 months, 12 and 24 months.DiscussionBecause of the lack of clinical studies that compare cement augmented locking plates with multiplanar humeral nail systems after 2-part surgical neck fractures of the proximal humerus, the decision of surgical method currently depends only on surgeons preference. Because only a randomized clinical trial (RCT) can sufficiently answer the question if one treatment option provides advantages compared to the other method we are planning to perform a RCT.Trial registrationClinical Trial (NCT02609906), November 18, 2015, registered retrospectively.

In Vitro Evaluation of the Tension Band Suture Method for Proximal Humerus Fracture Treatment

“…The multiple xation techniques described in literature indicate that the optimal treatment for displaced proximal humeral fractures continues to be controversial [7,8,11,19,20,21] FiberWire, a representative nonabsorbable suture made of multi-strand, long-chain, ultra-high molecular weight polyethylene (UHMWPE) demonstrated higher strength than the other conventional sutures as Barber et al reported; its superiority showed remarkable statistical signi cance in our study (P < 0.001) [27]. Moreover, the rupture pattern differed between FiberWire and the other suture materials.…”

In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

“…The multiple fixation techniques described in literature indicate that the optimal treatment for displaced proximal humeral fractures continues to be controversial [7,8,11,[19][20][21]. The preferred operation technique depends on fracture type, patient age, bone quality, and functional expectation.…”

Locking Intramedullary Nails Versus Locking Plates in the Treatment of 2-part and 3-part Proximal Humeral Surgical Neck Fractures in Elderly Patients: A Prospective Cohort Study

“…Treatment with locking intramedullary nails is more consistent with the principle of minimally invasive surgery [13,14]; however, this approach also has several disadvantages, such as the potential for screw displacement and iatrogenic rotator cuff tears [15,16]. The improved 3 rd generation locking intramedullary nails show better biomechanical advantages and a signi cantly reduced risk of rotator cuff tear because the nail entry point is in the muscle portion of the supraspinatus [17][18][19].…”