Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate

Robinson, C. M.; Wylie, John R.; Ray, Anna; Dempster, Niall; Olabi, Bayanne; Seah, Matthew; Akhtar, MA

doi:10.1302/0301-620x.92b5.22849

Cited by 50 publications

(46 citation statements)

References 23 publications

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“…The restoration of medial mechanical support of the fractures is an important factor that is emphasized for a successful clinical outcome in proximal humeral fractures. 14,24,25) Gardner et al 14) showed that when there is an unstable medial mechanical support by comminuted fractures at the proximal humerus, the positioning of the locking screws on the lower side of the humeral head along the humeral calcar is critical. In this study, we also highlighted that patients who showed contact of the medial humerus with the cortical bone or mechanical support of the medial humerus by the locking screws located on the humeral calcar had a greater Constant score, less change in humeral neck-shaft angle, and less change in humeral head height.…”

Section: Discussionmentioning

confidence: 99%

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

Lee¹,

Hwang²,

Kim³

et al. 2014

Clin Shoulder Elbow

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Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support. (Clin Shoulder

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Section: Discussionmentioning

confidence: 99%

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

Lee¹,

Hwang²,

Kim³

et al. 2014

Clin Shoulder Elbow

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“…A lateral plate can then be used to correct the translation of the medial shaft and reduce and fix the fragments into the anatomic position [7,24]. In cases where there is a significant metaphyseal bone defect, the defect may be filled with local bone graft or bone-graft substitute [25]. Alternatively, an allograft strut may be used to support the medial column, especially in cases of varus instability [26].…”

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

“…There have been several recent studies which have demonstrated satisfactory outcomes following ORIF of proximal humeral fractures [25,[27][28][29][30][31][32]. Brunner et al [27] treated 158 fractures and at 1 year follow up noted a Constant score of 72.…”

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

“…Solberg et al [28] found better clinical outcomes in older patients with three-and four-part proximal humeral fractures with initial valgus angulation (compared to those with initial varus angulation) and a metaphyseal segment attached to the articular fragment of greater than 2 mm. Robinson et al [25] treated 47 patients with a proximal humeral fracture in which there was a severe varus deformity. They used a standard operative protocol of anatomical reduction, fixation with a locking plate, and supplementation by structural allografts in unstable fractures and found a median Constant score of 86 at 2 years post-operatively.…”

Section: Open Reduction and Internal Fixationmentioning

confidence: 99%

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Proximal humeral fractures

2011

Orthopedic Trauma Directions

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Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percutaneous or open techniques to arthroplasty reconstructions. This article reviews the current literature on the classification and treatment options for proximal humeral fractures, while seeking to help the reader to define the most appropriate treatment plan for each individual patient with this type of fracture.

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“…7) Unreduced or poorly reduced fractures with varus angulation of the neck-shaft angle can be a cause of avascular necrosis of the head of humerus. [8][9][10] Nevertheless, the indications for selecting a specific treatment from the wide variety of available procedures like wires, sutures, intra-medullary nails and other fixation techniques 3) have all been used to maintain the fracture reduction. However, the ability of these fixations alone to restore anatomical relationships, maintain stability and prevent avascular necrosis to the humeral head remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Indirect Reduction Technique in Proximal Humeral Fractures Stabilized by Locking Plates

Rhee¹,

Cho²,

Won³

et al. 2014

Clin Shoulder Elbow

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Background: Indirect reduction technique offers a valid option in the treatment of proximal humerus fracture. The purpose of this study is to evaluate the functional outcome and the complication rate after indirect reduction and internal fixation of unstable proximal humeral fractures with use of a locking plate. Methods: Twenty four patients with acute proximal humerus fracture were managed with indirect reduction and internal fixation with a locking plate. The mean follow-up period was 15.5 months. Results:The anatomical reduction of the medial cortex buttress was seen in 16 patients (66%) of the Group A and the non-anatomical reduction was seen in 8 patients (33%) of the Group B. Mean union time was 3.2 ± 1.9 months; it was 2.2 ± 0.6 months in the Group A and 5.3 ± 2.2 months in the Group B (p < 0.05). In our series, there were 6 cases of complications and these include 2 cases of varus malunion, 2 cases of shoulder stiffness, 1 case of heterotrophic ossification, 2 cases of screw perforation and 1 case of impingement. Conclusions: We conclude from our studies that indirect reduction and internal fixation using locking plate for acute proximal humerus fracture can give good results with bony union and predictable good overall functional outcome. If the medial cortex buttress is well maintained, a better anatomical reduction would be achieved, the union would be prompted, the pain would be further reduced and the range of the motion would be recovered more promptly. (Clin Shoulder Elb 2014;17(1):2-9)

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Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate

Cited by 50 publications

References 23 publications

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

Proximal humeral fractures

Indirect Reduction Technique in Proximal Humeral Fractures Stabilized by Locking Plates

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