Surgical Treatment of Nonunions of the Surgical Neck of the Humerus

The use of a new locking 90° blade plate in the treatment of atrophic proximal humerus nonunions

“…Numerous techniques have been described and continue to evolve to increase the stability achieved in osteoporotic bone and in fractures or nonunion with small bone fragments. These include the use of double plating, combination of a plate and a nail, placement of the screws in divergent distribution, addition of cement to increase screw purchase [13], augmentation with onlay bone plate allograft [11], replacement of cortical 4.5 mm screws by 6.5 mm cancellous screws, placement of an intramedullary plate [6], use of blade plates [14], and stabiliaation with screws locked to the plate, whether by the addition of Schuhli nuts to standard plates or by the use of locked compression plates [20][21][22][23]. Although the use of hybrid fixation was initially not recommended and even though it is not yet established which is the biomechanically ideal construction for each particular case, recent publications recommend the use of combined or hybrid fixation [15], because the combination of screws in the hybrid configuration do not alter the mechanical properties of the construction [7].…”

“…Blade-plate fixation, in combination with autogenous iliac-crest bone grafting, has yielded good results when used for management of proximal humerus nonunions [14,18,22]. Biomechanical studies have shown that, compared to other types of available implants, the locking plate is comparatively flexible and maximises fracture stabilisation by minimising the peak stresses at the bone implant interface [16].…”

Nonunion of complex proximal humerus fractures treated with locking plate

“…Stable internal fixation is essential to obtain healing of an ununited fracture of the proximal humerus, 9 which could be achieved with use of Philos plate in our two patients. End-to-end alignment of the fragments usually does not provide good bone contact or stability for these fractures 11 and thus bone graft helps obliterate the cavitation (scalloping) of the humeral head fragment and substitutes bone stock deficiency. Commercially available bone graft proved a ready source of bone substitute and helped fill up the rest of the cavity left behind after the autogenous iliac crest bone graft was laid, thus avoiding further morbidity from accessing the other iliac crest.…”

The Outcomes of Proximal Humerus Fractures with Medial Metaphyseal Disruption Treated with Fibular Allograft Augmentation and Locking Plate

“…4,5) There are several known surgical treatments for humeral fractures, including closed reduction and percutaneous fixation, open reduction and internal fixation with plate, intramedullary nail fixation, hemiarthroplasty, such as transosseus suture fixation, and other several methods are known. [6][7][8] Among these, open reduction and internal fixation with locking-plate techniques are known to exhibit good results, and they are known to result in satisfactory outcomes when compared with techniques that use conventional plate in proximal humerus fractures.…”