The forgotten fragment: additional lesser tuberosity fixation of 4-part proximal humeral fractures—a biomechanical investigation

Katthagen, J. Christoph; Michel, P.; Raschke, Michael J.; Sußiek, Julia; Frank, André Günder; Wermers, Jens; Dyrna, Felix; Schliemann, Benedikt

doi:10.1016/j.jse.2021.04.041

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…The reconstruction of the NSA and the enhancement of medial support in the calcar region is a key factor when treating PHF [ 24 ]. Biomechanical studies have demonstrated the effectiveness of an anterior plate, especially for four-part fractures, to increase construct stability [ 27 , 28 , 36 , 37 ]. The mean NSA remained stable in our cohort from intraoperatively 131.5 ± 6.9° to 136.6 ± 13.7° at follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Michel

Raschke

Katthagen

et al. 2023

JCM

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Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. The mean age was 59.5 ± 12 years and the leading fracture type was a varus dislocation (Resch type IV in 55.3%). A head-split was present in 22.9% of the cases. The primary outcome measurement was the radiological neck shaft angle (NSA). The radiological follow-up was 21 ± 16.6 months and the NSA did not differ between the intraoperative and follow-up time point (131.5 ± 6.9° vs. 136.6 ± 13.7°; p = 0.267). The clinical follow-up was 29.5 ± 15.3 months. The Constant-score was 78.5 ± 17 points, the simple-shoulder-test (SST) was 9.3 ± 3.2 points and the subjective shoulder value (SSV) was 78.8 ± 19.5%. The over-all complication rate was 31.4%, and without stiffness 14.3%. An avascular necrosis occurred in two patients (5.7%). In conclusion, this study shows good radiological and functional outcomes after double plating of highly complex proximal humeral fractures, while the complication rate is comparable to the literature. Double plating is a viable option especially for younger patients with complex fractures as a potential alternative to fracture arthroplasty.

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Section: Discussionmentioning

confidence: 99%

“…For the proximal humerus, it is still a relatively new concept. Biomechanical studies indicate that a locked plate in combination with an additional anteriorly placed conventional plate can enhance construct stiffness and reduce fragment movement [ 27 , 28 ]. Clinical data is still limited.…”

Section: Introductionmentioning

confidence: 99%

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Michel

Raschke

Katthagen

et al. 2023

JCM

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“…12 Katthaggen et al also found in a cadaveric proximal humerus biomechanical study, that addition of an anterior plate to a lateral locked plate with cerclage fixation of the lesser tuberosity, offered improved stability and higher load to failure when compared to addition of only two anterior cortical screws. 11…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recently increased attention has been directed towards dual plate fixation in severely comminuted proximal humerus fractures, with both biomechanical and clinical studies indicating improved outcomes and less complications. [9][10][11][12][13] The aim of our case series is to describe our surgical technique of dual plate fixation in proximal humerus fractures, report our own experience with this technique and evaluate the clinical and radiological results in our series of patients.…”

Section: Introductionmentioning

confidence: 99%

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Dual plate fixation of proximal humerus fractures: Retrospective review and surgical technique

Al-Qahtani

Aljamaan

Abusultan³

et al. 2023

Shoulder & Elbow

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Introduction Recent interest has been directed towards dual plate fixation for comminuted proximal humerus fractures, with an aim to improve construct stability and thus improve patient outcomes while decreasing the risk of fracture-associated complications. We present our experience with this technique in a case series of patients with proximal humerus fractures and describe our surgical technique. Methodology This was a single-center retrospective case series of patients presenting with an acute (<6 weeks) proximal humerus fracture who underwent ORIF with dual plating fixation. Patient, fracture, and surgical data were collected. All patient outcomes were evaluated using Constant–Murley shoulder score and Single Assessment Numeric Evaluation. Results Our series included nine patients with a mean age of 46.2 years (range: 27–70 years old). All fractures healed within 4 months and no complications were encountered. At 1 year follow-up, the mean SANE score was 69.4% and the mean Constant Murley shoulder score was 78.9 (range: 70–96). Conclusion Our current series shows that applying the dual plating technique in severely comminuted proximal humerus fractures provides adequate fixation and thus good patient outcomes. Further research is required before this technique can be strongly recommended for management of these complex fractures. Level of Evidence Level 5.

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Arthroscopic Treatment of Lesser Tuberosity Avulsion Fractures

Katthagen

Oenning

2023

Arthroscopy and Endoscopy of the Shoulder

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The forgotten fragment: additional lesser tuberosity fixation of 4-part proximal humeral fractures—a biomechanical investigation

Cited by 7 publications

References 38 publications

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Double Plating for Complex Proximal Humeral Fractures: Clinical and Radiological Outcomes

Dual plate fixation of proximal humerus fractures: Retrospective review and surgical technique

Arthroscopic Treatment of Lesser Tuberosity Avulsion Fractures

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