Technical tips: Dualplate fixation technique for comminuted proximal humerus fractures

Choi, Sung Wook; Kang, Hyunseong; Bang, Hyeongsig

doi:10.1016/j.injury.2014.04.029

Cited by 43 publications

(39 citation statements)

References 6 publications

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“…The choice of approach is determined by the experience of different surgeons that a particular incision is more effective, safer, or that they are better at operating a particular approach. Although the traditional deltopectoral approach had the advantage of showing clear intermuscular space, its exposure to the posterior displaced greater tuberosity was limited [33]. Guilherme Grisi Mouraria [34] demonstrated that the anterolateral approach could better expose the lateral surface of the humerus, which was conducive to the operation, but the axillary nerve injury and subacromial impingement were still complications that couldn't be ignored.…”

Section: Discussionmentioning

confidence: 99%

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Gong¹,

Lin²,

Xu³

et al. 2020

Preprint

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Background: Previous studies had compared the effectiveness of surgical and conservative treatment in proximal humeral fracture (PHF), suggesting that both treatments were effective for displaced fractures. However, which treatment is more effective, especially in the elderly patient population, remains controversial to date. This study aims to evaluate the efficacy of the two treatment methods, including functional outcome scores, complications, etc.Methods: We searched four databases (MEDLINE, Web of Science, EMBASE, Cochrane Library) from the inception of the databases to March 2020. Within the scope of the search, the publication time and language of the relevant literatures were not limited. The meta-analysis directly compared the results and complications of the two groups and subgroups. Results: We included 11 comparative studies into our meta-analysis. The contents of the study included 7 randomized controlled trials (RCTs) and 4 non-randomized controlled trials (nRCTs). The pooled data demonstrated that there was no significant difference in postoperative Constant score between surgical and conservative treatment in the RCT subgroup, but there were differences among the nRCT and prosthesis subgroup. Although there was no significant difference between the surgery and conversation group in the major postoperative complications, the subgroup analysis showed fewer complications in the joint prosthesis replacement group. Conclusion: Both treatments could provide better clinical results for patients. The joint prosthesis replacement may offer additional benefits in terms of reduced complications and postoperative function. Furthermore, due to the increasing number of prosthesis replacements and the advent of the aging age, we should consider the individual differences between patients and enrich the clinical efficacy through the personal experience of surgeons before choosing treatment options.

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Section: Discussionmentioning

confidence: 99%

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Gong¹,

Lin²,

Xu³

et al. 2020

Preprint

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“…However, the drawbacks of LPSG include technical difficulty, limited supply, infection risk, and disease transmission risk. Dual-plate fixation has been used for comminuted proximal humeral fractures [16]. The LPDP system is used to prevent malunion and varus collapse of the neck-shaft portion, which are caused by severe comminution; however, only a limited number of patients have undergone this operation, and the biomechanical properties have not been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…The elastic modulus of the Ost bone was decreased by 33% for cortical bone and 66% for cancellous bone. Four types of fixation configurations (LP, LPMP, LPSG, and LPDP) were positioned into the proximal humeral fracture model according to standard surgical guidelines [8, 14, 16–19] (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

“…Gardner et al [14] used a locking plate combined with an intramedullary fibular graft (LPSG) to provide additional medial support and prevent varus malunion; this technique was tested successfully in cases of proximal humeral fracture with unstable medial support [13–15]. Choi et al [16] developed a dual-plate fixation technique for comminuted proximal humeral fracture in which a locking plate and the Variable Angle Locking Compression Plate Distal Radius System (LPDP) were used to prevent nonunion and varus collapse of the neck-shaft portion, which are caused by severe comminution.…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

Zhang

Wang

et al. 2017

J Orthop Surg Res

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BackgroundComminuted fractures of the proximal humerus are generally treated with the locking plate system, and clinical results are satisfactory. However, unstable support of the medial column results in varus malunion and screw perforation. We designed a novel medial anatomical locking plate (MLP) to directly support the medial column. Theoretically, the combined application of locking plate and MLP (LPMP) would directly provide strong dual-column stability. We hypothesized that the LPMP could provide greater construct stability than the locking plate alone (LP), locking plate combined with a fibular graft (LPSG), and locking plate combined with a distal radius plate (LPDP).MethodsLP, LPMP, LPSG, and LPDP implants were instrumented into the finite element model of a proximal humeral fracture. Axial, shear, and rotational loads were applied to the models under normal and osteoporotic bone conditions. The whole simulation was repeated five times for each fixator. To assess the biomechanical characteristics, the construct stiffness, fracture micromotion, stress distribution, and neck-shaft angle (NSA) were compared.ResultsThe LPMP group showed significantly greater integral and regional construct stiffness, and endured less von Mises stresses, than the other three fixation methods. The stresses on the lateral locking plate were dispersed by the MLP. The LPMP group showed the least change in NSA.ConclusionsFrom the finite element viewpoint, the LPMP method provided both lateral and medial direct support. The LPMP system was effective in treating proximal humeral fracture with an unstable medial column.

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“…Fixation of these fractures is ever evolving and the latest generation of implants allow fixation even of the most difficult fracture patterns [48][49][50]. Post-traumatic osteonecrosis of the humeral head has been shown to be a common problem that is more frequent in specific, more severe injury patterns.…”

Section: Managementmentioning

confidence: 99%

Post-traumatic osteonecrosis of the proximal humerus

Patel

Colaco

Elvey

et al. 2015

Injury

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Technical tips: Dualplate fixation technique for comminuted proximal humerus fractures

Cited by 43 publications

References 6 publications

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support

Post-traumatic osteonecrosis of the proximal humerus

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