Proximal Humeral SymposiumPitfalls and complications with locking plate for proximal humerus fracture
Section snippets
Patients and methods
Between 2004 and 2005, 73 acute 3- and 4-part displaced proximal humeral fractures underwent operative treatment with the same fixed angle locking-proximal-humerus-plate (LPHP – SYNTHES, Oberdorf, Switzerland) by different senior surgeons or under the direct supervision of a senior surgeon. During this period of time, no patient with unstable 3- or 4-part fractures has been treated with another technique (hemiarthroplasty, nails or pinning). Patients' charts were reviewed to collect data
Surgical technique
All surgeries were performed within the first week of the injury. An extended deltopectoral approach without detachment of the anterior deltoid was used in 14 cases (19.2%) and an anterosuperior approach through a deltoid-splitting in 59 cases (80.8 %). The periosteal attachment of the tuberosities and the diaphysis was preserved, and the medial hinge as well. The humeral head displacement was reduced to allow reduction of the tuberosities. Their osteosynthesis was performed with the use of
Postoperative follow-up
Patients were clinically and radiographically evaluated postoperatively at 6 weeks, 3, 6, 12 months. Postoperative evaluation for this study was conducted at a minimum of 18 months. Fourty-four patients agreed to come back for clinical and radiographic investigations. Eighteen patients were lost for follow-up: 5 died, 5 moved to another department, and 8 were too old to come back. Eleven patients need a second and a third surgery (4 secondary displacement, 2 screws cut out, 2 pseuarthrosis, 1
Results
Average follow-up was 20.7 months for the 44 patients called back for radiographic and clinical examination (range, 18-40 months). Three patients (4.1%) developed an adhesive capsulitis that needed an arthroscopic release after 2 years of evolution. Those patients had an anatomic reconstruction, without evidence of osteonecrosis or hardware malpositioning. There was 1 deep infection that needed 2 secondary surgeries and, finally, a resection arthoplasty. One patient with a healed fracture
Discussion
Locked fixed-angle screw implants with angular stability have been developed to improve the pullout strength of the screws inserted in a convergent or a divergent manner.8, 13, 14, 19, 25 Theoretically, these plates provide more secure fixation of proximal humeral fractures, especially in weak or oteoporotic bones.28 Nevertheless, the complication rate associated with remains high (over 10%1) and the mode of failure is different than conventional plates. Two types of complications need to be
Conclusion
We would like to emphasis the cutout and complication rate of this osteosynthesis material. We recommend careful consideration of the decision-making between ORIF and fracture-dedicated arthroplasties for 4-part fractures of the proximal humerus in patients with osteopenia, particularly when the bone-stock and the humeral head are thin. There is no real consensus regarding the optimal treatment for such fractures.31 Nevertheless, it has been shown that in a selected cohort of patients,
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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