Locking plate fixation for proximal humeral fractures: initial results with a new implant.

Treatment of proximal humeral fractures remains controversial, with multiple reported techniques and variable results. Recently, locking plates have become available for fixation of osteopenic and comminuted fractures. This study reports our initial experience with a new locking plate designed specifically for proximal humeral fractures. We observed 16 patients until union or revision with a mean of 12 months' follow-up. Of the 16 patients, 9 had high-energy injuries. There were nine 3-part, five 2-part, and two 4-part fractures. Twelve of sixteen patients healed without complications. There were 4 nonunions; all occurred in patients with 3-part fractures with metadiaphyseal comminution, 3 of whom were heavy smokers. In patients with united fractures, mean elevation was 132 degrees and mean external rotation was 43 degrees, with mean internal rotation to T11. Locking plate fixation achieved union in 75% of patients in this series. Risk factors for delayed union or nonunion included comminution, smoking, and 3-part fractures. These fractures remain challenging despite the availability of locked plating systems.

[1]  A. J. Wijgman,et al.  Open Reduction and Internal Fixation of Three and Four-Part Fractures of the Proximal Part of the Humerus , 2002, The Journal of bone and joint surgery. American volume.

[2]  P. Kannus,et al.  Osteoporotic fractures of the proximal humerus in elderly Finnish persons: Sharp increase in 1970-1998 and alarming projections for the new millennium , 2000, Acta orthopaedica Scandinavica.

[3]  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.

[4]  B. Kristiansen,et al.  Plate fixation of proximal humeral fractures. , 1986, Acta orthopaedica Scandinavica.

[5]  P. Hoffmeyer,et al.  Fixation of fractures of the proximal humerus with the PlantTan Humerus Fixator Plate: early experience with a new implant. , 2003, Journal of shoulder and elbow surgery.

[6]  J. Iannotti,et al.  Displaced Three‐ and Four‐Part Proximal Humerus Fractures: Evaluation and Management , 2000, The Journal of the American Academy of Orthopaedic Surgeons.

[7]  C. Court-Brown,et al.  Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. , 2002, The Journal of bone and joint surgery. British volume.

[8]  G. Haidukewych.  Innovations in locking plate technology. , 2004, The Journal of the American Academy of Orthopaedic Surgeons.

[9]  J. Pajarinen,et al.  Internal fixation of proximal humeral fractures with a locking compression plateA retrospective evaluation of 72 patients followed for a minimum of 1 year , 2004, Acta orthopaedica Scandinavica.

[10]  C. Court-Brown,et al.  The translated two-part fracture of the proximal humerus , 2001 .

[11]  D. Korres,et al.  Fixation of Proximal Humerus Fractures Using the PHILOS Plate: Early Experience , 2006, Clinical orthopaedics and related research.

[12]  M. C. Hall,et al.  The Structure of the Upper End of the Humerus with Reference to Osteoporotic Changes in Senescence Leading to Fractures. , 1963, Canadian Medical Association journal.

[13]  N. Shrive,et al.  Semitubular blade plate fixation in proximal humeral fractures: a biomechanical study in a cadaveric model. , 1998, Journal of shoulder and elbow surgery.

[14]  R. Hawkins,et al.  Displaced Proximal Humeral Fractures: Evaluation and Treatment , 1994, The Journal of the American Academy of Orthopaedic Surgeons.

[15]  Steven C. Chudik,et al.  Fixed-angle plate fixation in simulated fractures of the proximal humerus: a biomechanical study of a new device. , 2003, Journal of shoulder and elbow surgery.

[16]  Florian Fankhauser,et al.  A New Locking Plate for Unstable Fractures of the Proximal Humerus , 2005, Clinical orthopaedics and related research.

[17]  R. Hawkins,et al.  The three-part fracture of the proximal part of the humerus. Operative treatment. , 1986, The Journal of bone and joint surgery. American volume.