Reduction and fixation of proximal humeral fracture with severe medial instability using a small locking plate

Abstract

Background Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed. Methods Fifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Results The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Complications such as infection and neurovascular injury were not observed. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. The mean Constant score was 79.8 (range, 68–92) during the final visit. Conclusions The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability.

The effect of integrity of lesser tuberosity-medial calcar on postoperative outcome in the proximal humeral fracture

“…In view of the high incidence of postoperative complications, some investigators have suggested that an adjuvant plate or fibular strutallograft (FSA) could be used for additional fixation in addition to PHILOS [ 20 , 21 ]. The plates can be placed in various positions, including the anterior and medial to the proximal humerus [ 6 , 22 ]. However, the technique of anterior plate assisted internal fixation has rarely been described, and few studies have been performed on the effect of lesser tuberosity fractures and their associated medial calcar disruption on patients with proximal humerus fractures.…”

“…Studies have concluded that the integrity of the medial structure is closely related to postoperative complications. If the medial cortex cannot provide effective support during the operation, the medial column collapse will occur even with the fixation of the calcar screws [ 6 , 7 ]. The collapsed humeral head is associated with long-term postoperative pain and functional limitations of the shoulder joint.…”