Second generation locked plating of proximal humerus fractures—A prospective multicentre observational study

Abstract

Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis. Locking plates are intended to provide superior mechanical stability. In a prospective multicentre study 131 patients were treated with second generation locked plating (NCB-PH, Zimmer, Inc.). The open procedure (n=78) was performed using a deltopectoral approach; the minimally invasive technique (n=53) involved percutaneous reduction and an anterolateral deltoid split approach. Clinical and radiological follow-up was obtained. Improvement in function (ROM) was statistically significant. Fracture type (AO) had the most significant impact on the incidence of complications. The most frequent complications detected were intra-articular screw perforation (15%) and secondary displacement (8%). Complication rate and functional outcome of the NCB-PH are comparable to reports in the literature. Not all problems are likely to be solved by this new generation of implants, i.e. secondary dislocation still occurred in 8% of our patients.

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

“…On the other hand, in a small nonrandomized study, Wu et al found no radiological differences with respect to reduction of the fracture postoperatively and the head displacement during followup [22]. Röderer et al found higher incidences of intraarticular screw perforation (deltoid-split 17.0% versus deltopectoral 12.8%) but lower rates of proximal screw loosening (deltoid-split 1.9% versus deltopectoral 1.3%) as compared with our results without differences between the different approaches [17]. Finally, Hepp et al found also the same complication rates with both approaches.…”

“…Proximal humerus fractures are common, and the evidence base comparing the available surgical approaches does not include randomized trials [11,17,22]. This prospective randomized study was performed to evaluate the clinical outcomes after osteosynthesis of proximal humeral fractures with a polyaxial locking plate using either the less invasive, deltoid-split approach or the deltopectoral approach, specifically evaluating for differences in complication rate, function, and pain.…”

“…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).…”

“…As an alternative, a less invasive, deltoid- split approach has been described with the goal of minimizing local soft tissue trauma. Early results with this approach have been shared [16,18], although only a few nonrandomized trials have compared the two approaches [11,17,22]. In light of the deficiencies in the existing evidence base, we initiated a randomized controlled trial.…”

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

“…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.…”