Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study.

BACKGROUND The surgical treatment for displaced humeral head fractures overlooks a broad variety of surgical techniques and implant systems. A standard operative procedure has not yet been established. In this article, we report our experience with a second-generation locking plate for the humeral head fracture that is applied in a standardized nine-step minimally invasive surgical technique (MIS). METHODS In a prospective study from May 2008 until November 2009, a cohort of 79 patients with 80 proximal humerus fractures were operated in a MIS procedure using a polyaxial locking plate. Follow-up examination at 6 weeks and 6 months postoperative included radiologic examinations and a clinical outcome analysis by the Constant Score, the Visual Analog Scale for pain, and the Daily Activity Score. RESULTS The mean patient age was 65.5 years ± 19 years. According to the Neer classification, there were 18 (22.5%) two-part (Neer III), 48 (60%) three-part (Neer IV), and 14 (17.5%) four-part fractures (Neer IV/V). The operation time averaged 65.6 minutes ± 27 minutes. In 13 patients (16.3%), revision was necessary because of procedure-related complications. After 6 months, the Visual Analog Scale for pain was 2.7 ± 1.6 and the Daily Activity Score showed 19.6 ± 6 points. The average age-related Constant Score after 6 months was 67.5 ± 24 points. CONCLUSIONS MIS surgery of displaced humeral head fractures can be performed in all types of humeral head fractures leading to low complication rates and good clinical outcome. A standardized stepwise procedure in fracture reduction and fixation is recommended to achieve reliable good results.

[1]  M. Kääb,et al.  Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. , 2009, The Journal of bone and joint surgery. American volume.

[2]  H. Resch,et al.  Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. , 2008, The Journal of bone and joint surgery. British volume.

[3]  C. Müller,et al.  Minimalinvasive T-Plattenosteosynthese am proximalen Humerus , 2008 .

[4]  D. Oswald,et al.  Standardverfahren zur Behandlung proximaler Humerusfrakturen , 2008, Trauma und Berufskrankheit.

[5]  H. Lill,et al.  The surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome. , 2008, Journal of shoulder and elbow surgery.

[6]  R. Hertel,et al.  Initial post-fracture humeral head ischemia does not predict development of necrosis. , 2008, Journal of shoulder and elbow surgery.

[7]  H. Zwipp,et al.  Winkelstabile Plattenosteosynthese für proximale Humerusfrakturen , 2008, Trauma und Berufskrankheit.

[8]  Florian Gebhard,et al.  Minimally Invasive Application of the Non-Contact-Bridging (NCB) Plate to the Proximal Humerus: An Anatomical Study , 2007, Journal of orthopaedic trauma.

[9]  L. Kinzl,et al.  [The Non-Contact Bridging Plate. A new fixed-angle device for the minimally-invasive treatment of fractures of the proximal humerus--technique and preliminary results]. , 2007, Der Unfallchirurg.

[10]  C. Becker,et al.  [Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65]. , 2006, Zeitschrift fur Gerontologie und Geriatrie.

[11]  P. Biberthaler,et al.  Die winkelstabile Osteosynthese am proximalen Humerus mit der PHILOS-Platte , 2006, Der Unfallchirurg.

[12]  G. Matthes,et al.  Ergebnisse nach Versorgung instabiler proximaler Humerusfrakturen mittels winkelstabiler Platte , 2006, Der Unfallchirurg.

[13]  C. Voigt,et al.  Komplikationsmanagement nach winkelstabiler Plattenosteosynthese am proximalen Humerus , 2006, Der Chirurg.

[14]  B. Cole,et al.  Normalization of the Constant score. , 2005, Journal of shoulder and elbow surgery.

[15]  H. Lill,et al.  [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach - technique and first results]. , 2004, Zentralblatt fur Chirurgie.

[16]  S. Mawson,et al.  Rehabilitation after two-part fractures of the neck of the humerus. , 2003, The Journal of bone and joint surgery. British volume.

[17]  P. Rommens,et al.  Osteosynthesetechniken bei proximalen Humerusfrakturen , 2001, Der Chirurg.

[18]  H. Lill,et al.  Konservative oder operative Versorgung der Humeruskopffraktur beim alten Menschen? , 2001, Der Chirurg.

[19]  C. Court-Brown,et al.  The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. , 2001, The Journal of bone and joint surgery. British volume.

[20]  G. Walch,et al.  Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. , 2001, Journal of shoulder and elbow surgery.

[21]  H. Lill,et al.  Proximale und distale Humerusfrakturen im hohen Alter , 2000, Der Orthopäde.

[22]  B. Hintermann,et al.  Primary endoprosthesis in comminuted humeral head fractures in elderly patients , 1997, Der Unfallchirurg.

[23]  K. Müller,et al.  [Modified treatment concept in fractures of the humeral head in elderly patients]. , 1996, Der Unfallchirurg.