Use of locking plates in the treatment of proximal humerus fractures

Ricchetti, Eric T.; Warrender, William J.; Abboud, Joseph A.

doi:10.1016/j.jse.2010.01.001

Cited by 92 publications

(62 citation statements)

References 50 publications

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“…1 However, some studies show variable results with high rates of screw perforation of the articular surface or varus collapse of the fracture, especially in osteoporotic bone or in fractures with medial metaphyseal comminution. [2][3][4][5][6][7][8] Adequate mechanical support of the medial column may be obtained by achieving an anatomically stable reduction with a medial cortical contact or, in the case of medial comminution, by placing a superiorly directed oblique locking screw in the inferomedial region of the proximal fragment. Indeed, studies show that fractures treated with either anatomic reduction or screws in the inferomedial humeral head for which no medial column support was obtained had a high incidence of failure.…”

Section: Introductionmentioning

confidence: 99%

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Matassi

Angeloni

Carulli

et al. 2012

Injury

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Section: Introductionmentioning

confidence: 99%

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Matassi

Angeloni

Carulli

et al. 2012

Injury

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“…34 There is no general agreement on the optimal treatment for these fractures, and 1 of 9 patients treated with open reduction-internal fixation (ORIF) or hemiarthroplasty requires revision surgery 21 because of often serious complications. 6,9,25,29,37,41,45 An acceptable solution should take the osteoporotic bone especially of the greater tuberosity into account and ensure a predictable and rapid postoperative recovery of the ability to perform daily activities, independent of patient compliance and capability of postoperative rehabilitation. The use of a reverse total shoulder replacement (reverse total shoulder arthroplasty [RTSA]) as proposed by Grammont et al 19 is an alternative that addresses the additional fragility of the rotator cuff and has shown promising results in a few case series.…”

mentioning

confidence: 99%

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Grubhofer

Wieser

Meyer

et al. 2016

Journal of Shoulder and Elbow Surgery

128

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Due to the aging population with poor bone quality the frequency of complex proximal humerus fractures increases. An operative reconstruction and internal fixation is very challenging and is not always possible. Secondary impaction, screw perforations and humeral head necrosis is a common complication. The use of a Reverse Total Shoulder Arthroplasty in the elderly after trauma is a promising alternative. The present multicenter study retrospectively analyzes our long-term experience of reverse total shoulder arthroplasty as a primary treatment in this patient population regarding pain, range of shoulder motion, subjective shoulder value, the constant score, scapular notiching and signs of loosening. Background: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Methods: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). Results: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. Conclusion:The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Level of evidence: Level IV; Case Series; Treatment Study

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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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Use of locking plates in the treatment of proximal humerus fractures

Cited by 92 publications

References 50 publications

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Locking plate and fibular allograft augmentation in unstable fractures of proximal humerus

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

Evidence for Success with Locking Plates for Fragility Fractures

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