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Outcome of Proximal Humerus Fractures Treated Surgically by Locking Plate- a Retrospective Case-Series Study

Year 2024, Volume: 15 Issue: 4

Emre Kaya , Mehmet Oğuz Durakbaşa

https://doi.org/10.31067/acusaglik.1387274

Abstract

Objectives: To evaluate functional outcomes, radiographic findings and complications of proximal humerus fractures(PHFs) treated surgically by osteosynthesis with locking plate(OLP)(Philos®), to determine unpredictable results after surgery and find out solutions for successful clinical outcomes. Patients and Methods: Twenty-five patients were evaluated retrospectively. Constant shoulder score, ASES shoulder score and range of motion(ROM) were used to evaluate clinical outcome. Preoperative and final follow-up radiographs were used and humeral neck-shaft inclination angle described by Boileau and avascular necrosis(AVN) of the humeral head evaluated by Cruess classification were recorded to judge radiological outcome. Results: Patients were 58(28-92) years old. The median Constant and ASES scores were 80(IQR 60-89) and 80(IQR 60-95) respectively. Neck-shaft inclination angle was 135(IQR 120-144) degrees at the final follow-up. 11 patients (44%) had complications. Major complications were AVN and varus malunion and both had a rate of 12% individually. Technical errors during surgery, mainly placing the pate high and screw-related complications, had adverse affect on AVN and varus malunion. Constant and ASES shoulder scores were not affected significantly by age, gender, AO and Neer fracture types and concomitant injuries. The clinical outcome has significantly become worse if varus malunion and/or AVN proceeded. Revision rate was 20% and its leading cause was AVN. Conclusion: Age, gender, fracture type and additional fracture elsewhere did not affect clinical outcome significantly. OLP is a reliable option for PHFs that can be used in all age groups and fracture types. OLP for PHFs had favorable radiological and clinical outcomes unless varus malunion and/or AVN of the humeral head proceeded postoperatively.

Keywords

procimal humeral fracture locking plate surgical tips complications outcomes

References

  • 1. Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res. 2017;12:137.
  • 2. Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury 2019;50:2176-2195.
  • 3. Chen H, Zhu ZG, Li JT, Chang ZH, Tang PF. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column stability: A cohort study. Int J Surg. 2020;73:50-56.
  • 4. Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;24:6:50.
  • 5. Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extrem. 2018;13:123-9.
  • 6. Warnhoff M, Jensen G, Dey Hazra RO, Theruvath P, Lill H, Ellwein A. Double plating-surgical technique and good clinical results in complex and highly unstable proximal humeral fractures. Injury 2021;52:2285-91.
  • 7. Schnetzke M, Bockmeyer J, Loew M, Studier-Fischer S, Grützner PA, Guehring T. Rate of avascular necrosis after fracture dislocations of the proximal humerus: Timing of surgery. Obere Extrem. 2018;13(4):273-8.
  • 8. Neer CS. Articular replacement for the humeral head. J Bone Joint Surg Am. 1955;37-A(2):215-228.
  • 9. Jakob RP, Ganz R. Proximale Humerusfrakturen. Helv Chir Acta. 1981;48(5):595-610.
  • 10. Boileau P, Walch G. The tree-dimensional geometry of the proximal humerus. J Bone Joint Surg Br. 1997;79(5):857-865.
  • 11. Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures: an anatomical cadaver study. J Bone Joint Surg Br. 1993;75(1):132-136.
  • 12. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-164.
  • 13. Michener LA, Mcclure PW, Senneth BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594.
  • 14. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19(4):489-494.
  • 15. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma 2008;22(3):159-164.
  • 16. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90(2):233-240.
  • 17. Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K. Does fixed-angle plate osteosynthesis solve the problem of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop. 2009;80(1):92-96.
  • 18. Sproul RC, Iyengar JI, Zlatko Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury 2011;42(4):408-413.
  • 19. Rouleau DM, Laflamme GY, Berry GK, Harvey EJ, Delisle J, Girard J. Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res. 2009;95(1):56-62.
  • 20. Agudelo J,Schürmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy nd failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 2007;21(10):676-681.
  • 21. Iacobellis C, Fountzoulas K, Aldegheri R. Plating of proximal fracture of the humerus: a study of 30 cases. Musculoskelet Surg. 2011;95 Suppl-1:S43-48.
  • 22. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91(7):1689–1697.
  • 23. 16. Handschin AE, Cardell M, Contaldo C, Trenzt O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury 2008; 39(3):306-313.
  • 24. Grassi FA, Alberio R, Ratti C, Surace MR, Piazza P, Messinese P, Saccomanno MF, Maccauro G, Murena L. Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont. Orthop Rev. (Pavia) 2020;12(Suppl 1):8659.
  • 25. Gigis I, Nenopoulos A, Giannekas D, Heikenfeld R, Beslikas T, Hatzokos I. Reverse shoulder arthroplasty for the treatment of 3 and 4-part fractures of the humeral head in the elderly. Open Orthop J. 2017; 11:108-118.
  • 26. Schliemann B, Siemoneit J, Theisen C, Kösters C, Weimann A, Raschke MJ. Complex fractures of the proximal humerus in the elderly--outcome and complications after locking plate fixation. Musculoskelet Surg. 2012; 96 Suppl 1:S3-11.
  • 27. Jordan RW, Modi CS. A review of management options for proximal humeral fractures. Open Orthop J. 2014; 8:148-56.

Year 2024, Volume: 15 Issue: 4

Emre Kaya , Mehmet Oğuz Durakbaşa

https://doi.org/10.31067/acusaglik.1387274

Abstract

References

  • 1. Laux CJ, Grubhofer F, Werner CML, Simmen HP, Osterhoff G. Current concepts in locking plate fixation of proximal humerus fractures. J Orthop Surg Res. 2017;12:137.
  • 2. Panagiotopoulou VC, Varga P, Richards RG, Gueorguiev B, Giannoudis PV. Late screw-related complications in locking plating of proximal humerus fractures: A systematic review. Injury 2019;50:2176-2195.
  • 3. Chen H, Zhu ZG, Li JT, Chang ZH, Tang PF. Finite element analysis of an intramedulary anatomical strut for proximal humeral fractures with disrupted medial column stability: A cohort study. Int J Surg. 2020;73:50-56.
  • 4. Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM. The calcar screw in angular stable plate fixation of proximal humeral fractures--a case study. J Orthop Surg Res. 2011;24:6:50.
  • 5. Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extrem. 2018;13:123-9.
  • 6. Warnhoff M, Jensen G, Dey Hazra RO, Theruvath P, Lill H, Ellwein A. Double plating-surgical technique and good clinical results in complex and highly unstable proximal humeral fractures. Injury 2021;52:2285-91.
  • 7. Schnetzke M, Bockmeyer J, Loew M, Studier-Fischer S, Grützner PA, Guehring T. Rate of avascular necrosis after fracture dislocations of the proximal humerus: Timing of surgery. Obere Extrem. 2018;13(4):273-8.
  • 8. Neer CS. Articular replacement for the humeral head. J Bone Joint Surg Am. 1955;37-A(2):215-228.
  • 9. Jakob RP, Ganz R. Proximale Humerusfrakturen. Helv Chir Acta. 1981;48(5):595-610.
  • 10. Boileau P, Walch G. The tree-dimensional geometry of the proximal humerus. J Bone Joint Surg Br. 1997;79(5):857-865.
  • 11. Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures: an anatomical cadaver study. J Bone Joint Surg Br. 1993;75(1):132-136.
  • 12. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160-164.
  • 13. Michener LA, Mcclure PW, Senneth BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594.
  • 14. Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19(4):489-494.
  • 15. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma 2008;22(3):159-164.
  • 16. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90(2):233-240.
  • 17. Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K. Does fixed-angle plate osteosynthesis solve the problem of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop. 2009;80(1):92-96.
  • 18. Sproul RC, Iyengar JI, Zlatko Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury 2011;42(4):408-413.
  • 19. Rouleau DM, Laflamme GY, Berry GK, Harvey EJ, Delisle J, Girard J. Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res. 2009;95(1):56-62.
  • 20. Agudelo J,Schürmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy nd failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 2007;21(10):676-681.
  • 21. Iacobellis C, Fountzoulas K, Aldegheri R. Plating of proximal fracture of the humerus: a study of 30 cases. Musculoskelet Surg. 2011;95 Suppl-1:S43-48.
  • 22. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91(7):1689–1697.
  • 23. 16. Handschin AE, Cardell M, Contaldo C, Trenzt O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury 2008; 39(3):306-313.
  • 24. Grassi FA, Alberio R, Ratti C, Surace MR, Piazza P, Messinese P, Saccomanno MF, Maccauro G, Murena L. Shoulder arthroplasty for proximal humerus fractures in the elderly: The path from Neer to Grammont. Orthop Rev. (Pavia) 2020;12(Suppl 1):8659.
  • 25. Gigis I, Nenopoulos A, Giannekas D, Heikenfeld R, Beslikas T, Hatzokos I. Reverse shoulder arthroplasty for the treatment of 3 and 4-part fractures of the humeral head in the elderly. Open Orthop J. 2017; 11:108-118.
  • 26. Schliemann B, Siemoneit J, Theisen C, Kösters C, Weimann A, Raschke MJ. Complex fractures of the proximal humerus in the elderly--outcome and complications after locking plate fixation. Musculoskelet Surg. 2012; 96 Suppl 1:S3-11.
  • 27. Jordan RW, Modi CS. A review of management options for proximal humeral fractures. Open Orthop J. 2014; 8:148-56.
There are 27 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Research Articles
Authors

Emre Kaya 0000-0002-9493-8790

Mehmet Oğuz Durakbaşa 0000-0002-5886-312X

Early Pub Date September 17, 2024
Publication Date
Submission Date November 8, 2023
Acceptance Date May 7, 2024
Published in Issue Year 2024Volume: 15 Issue: 4

Cite

EndNote Kaya E, Durakbaşa MO (September 1, 2024) Outcome of Proximal Humerus Fractures Treated Surgically by Locking Plate- a Retrospective Case-Series Study. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 15 4
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