The Use of Precontoured Humeral Locking Plates in the Management of Displaced Proximal Humerus Fracture

Ricchetti, Eric T.; DeMola, Philip M.; Roman, Don; Abboud, Joseph A.

doi:10.5435/00124635-200909000-00005

Cited by 28 publications

(22 citation statements)

References 26 publications

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“…We prefer diverging patterns to increase the spread of screws into the humeral head. 39 Smaller holes around the proximal end of the plate are also present to allow placement of Kirschner wires for temporary intraoperative fixation, or for passing of suture for additional fixation. It is our practice to augment the locking plate construct with sutures passed through the rotator cuff and proximal plate to increase fracture stability.…”

Section: Preoperative Considerationsmentioning

confidence: 99%

Use of locking plates in the treatment of proximal humerus fractures

Ricchetti

Warrender

Abboud

2010

Journal of Shoulder and Elbow Surgery

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Section: Preoperative Considerationsmentioning

confidence: 99%

Use of locking plates in the treatment of proximal humerus fractures

Ricchetti

Warrender

Abboud

2010

Journal of Shoulder and Elbow Surgery

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“…Since 2006, nine case series have been reported in ten publications [13,19,42,43,45]. One series was reported on twice [28,50].…”

Section: Resultsmentioning

confidence: 99%

Evidence for Success with Locking Plates for Fragility Fractures

Cornell

Ayalon

2011

HSS Jrnl

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Fixation of fragility fractures with plates and screws often results in loss of fixation and need for revision surgery. Locking plates and screw were introduced to improve fixation of fragility fractures and have been in use for a decade. This review was conducted to compile evidence that locking plates and screws improve fixation of fragility fractures. A search of PubMed was performed to identify biomechanical studies as well as clinical series of fragility fractures treated with locking plates. Biomechanics papers had to use models of osteoporotic bone and had to directly compare locking plates with traditional plates. Clinical studies included case series in which locking plates were applied to elderly patients with fractures of the proximal humerus and periprosthetic distal femur fractures. Most studies are retrospective case series. Locking plates lead to greater stability and higher loads to failure than traditional plates. When applied to proximal humerus fractures, uncomplicated healing occurs in 85% of patients. Constant and Dash scores approach normal values. For distal femoral periprosthetic fractures, union rates of 75% are reported with a malunion rate of 10%. Early evidence suggests that locking plates improve results of treatment of proximal humerus fractures and distal femoral periprosthetic fractures in the elderly. Loss of fixation is associated with failure to achieve stability at the fracture site. Principles of fracture fixation in osteoporotic bone defined prior to the introduction of locking plates should still be applied.

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“…Locking plates may also produce a fixation construct stable enough to allow early range of motion exercises. 3 Even in fractures of the humeral shaft region, a recent Cochrane review found higher rates of sub-acromial impingement and the need for implant removal with locked nails compared to compression plates, although both fixation techniques had similar early complication rates and functional outcomes. 13 A study of 18 long PHILOS plate fixations for a mixture of pathologies by Pimple et al reported no non-unions, with a mean residual pain of 0.8 as assessed by the VAS.…”

Section: Discussionmentioning

confidence: 99%

“…9 The use of contoured locking plate fixation devices for the treatment of these fractures is becoming increasingly popular. 3,10,11 Locking plate devices are particularly suited for metaphyseal fractures where there is comminution and loss of bone as the fixed angle nature of the construct resists cantilever bending stresses. 10,12 It is also proposed that the decreased plate to bone compression reduces the interference with local microvascular circulation.…”

Section: Discussionmentioning

confidence: 99%

“…2 It is well recognized that the functional outcome of proximal humerus fractures is best when the tuberosity fragments are well reduced and aligned with the shaft. 3 A relatively recent advance in the treatment of proximal humerus fractures has been the introduction and wide spread adoption of contoured locking plates. 3,4 Although much has been written in the published Department of Trauma and Orthopaedics, Royal Liverpool & Broadgreen University Hospitals, Liverpool, UK literature about the experience with these locking plates for the more common proximal humeral fractures, there is a paucity of data available with respect to outcome for their use in proximal humerus fractures with distal extension of the fracture line.…”

Section: Introductionmentioning

confidence: 99%

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Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

et al. 2014

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Background: There is a paucity of data available with respect to outcome on long contoured locking plate fixation for proximal humerus fractures with distal fracture extension. Methods: Thirty-four patients with traumatic proximal humerus fractures with distal extension underwent fixation with long contoured locking plates. Twenty-five patients (74%) were included in the study: one patient died, two patients had unrelated illnesses resulting in them being unable to complete follow-up assessment and six were lost to follow-up. Patients' case notes and radiographs were retrospectively reviewed, and patients were contacted to assess functional outcome using the Visual Analogue Scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) score, Oxford Shoulder Score (OSS) and Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Results: Mean follow-up was 27 months (range 11 months to 60 months). Mean pain at final follow-up was 3.6 [95% confidence interval (CI) ¼ 2.5 to 4.8] with only four patients having residual pain greater than 5 on the VAS scale. Mean DASH score was 41.2 (95% CI ¼ 32.0 to 50.4), mean OSS was 29.1 (95% CI ¼ 24.3 to 33.9) and mean SPONSA was 63.9% (95% CI ¼ 50.8 to 77.2). There was one wound infection. Three patients had non-unions that required bone grafting and revision internal fixation. Conclusions: We feel long contoured locking plates represent a useful treatment option for complex proximal humerus fractures

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The Use of Precontoured Humeral Locking Plates in the Management of Displaced Proximal Humerus Fracture

Cited by 28 publications

References 26 publications

Use of locking plates in the treatment of proximal humerus fractures

Use of locking plates in the treatment of proximal humerus fractures

Evidence for Success with Locking Plates for Fragility Fractures

Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension

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