Risk Analysis of Locking Plate for 3-part or 4-part Proximal Humerus Fracture_West China Medical Journal

Authors：

 TANGShi-tian ¹ , WANGJun ¹ , SHIBo ¹ , WANGTao ¹ , YANGHeng ¹ , KANGBin ¹ , ZHANGDing-wei ¹ ,  LIUGang ¹ , HUANGFu-guo ²

1. Department of Orthopedics, Mianyang Central Hospital, Mianyang 621000, P. R. China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIUGang, Email: liugang@163.com

Keywords：

Proximal humerus fracture; Elder patient; Clinical outcome; Prognostic factors

DOI：

10.7507/1002-0179.20150123

Video：

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Objective To analyze the outcome and prognostic factors of using locking plate for treating proximal humerus fracture. Methods Between January 2005 and January 2012, 45 aged patients with a displaced 3-part or 4-part fracture of the proximal humerus were treated by locking plate. Range of motion and Constant-Mudey score were observed during the follow-up. Results Forty-three patients were followed up from 12 to 48 months with an average of 18 months. The mean final Constant-Mudey score was 72.3±9.5 and 6 of them needed a second surgery. In addition to fracture type, other prognostic factors included redisplacement (4 cases, 9.3%), nonunion (3 cases, 7.0%), crashing (3 cases, 7.0%), necrosis of the humeral head (6 cases, 14.0%) and screw cut-out (5 cases, 11.6%). Among the patients with disrupted medial calcar, 4 needed a second surgery at the final follow-up, 3 had redisplacement, 2 had nonunion, and 2 had screw cut-out. Conclusion Locked screw-plates provide more secure fixation of fracture in aged patients, but the complication rate remains high. We suggest anatomic reduction, and plate and screws position, length of the screws, the medial cortical contact and stability may be the chief prognostic factors affecting the shoulder function following a proximal humeral fracture.

Citation： TANGShi-tian, WANGJun, SHIBo, WANGTao, YANGHeng, KANGBin, ZHANGDing-wei, LIUGang, HUANGFu-guo. Risk Analysis of Locking Plate for 3-part or 4-part Proximal Humerus Fracture. West China Medical Journal, 2015, 30(3): 417-420. doi: 10.7507/1002-0179.20150123 Copy

1.	Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures[J]. Clin Orthop Relat Res, 2006, 442(12):87-92.
2.	Cadossi M, Mazzotti A, Capra C, et al. Proximal humeral fractures in elderly patients[J]. Aging Clin Exp Res, 2013, 25(1):S85-S87.
3.	魏均强, 张伯勋, 唐佩福, 等. 肱骨近端骨折分型和诊治进展[J]. 中华创伤杂志, 2010, 26(11):1053-1056.
4.	Namdari S, Horneff JG, Baldwin K. Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures a systematic review[J]. J Bone Joint Surg Am, 2013, 95(18):1701-1708.
5.	Lanting B, Macdermid J, Drosdowech D, et al. Proximal humeral fractures:a systematic review of treatment modalities[J]. J Shoulder Elbow Surg, 2008, 17(1):42-54.
6.	Lill H, Josten C. Conservative or operative treatment of humeral head fractures in the elderly?[J]. Chirurg, 2001, 72(11):1224-1234.
7.	袁本祥, 董英海, 刘祖德, 等. 肱骨近端关节囊内骨折的预后判断标准[J]. 中华骨科杂志, 2006, 26(7):464-467.
8.	Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures[J]. J Bone Joint Surg Am, 2009, 91(7):1689-1697.
9.	Foruria AM, De Gracia MM, Larson DR, et al. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures[J]. J Bone Joint Surg Br, 2011, 93(3):378-386.
10.	Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus[J]. J Shoulder Elbow Surg, 2004, 13(4):427-433.
11.	曾浪清, 陈云丰, 唐三元. 不同内侧柱支撑重建对锁定钢板固定治疗肱骨近端骨折的影响[J]. 中华创伤骨科杂志, 2014, 16(1):6-11.
12.	黄强, 王满宜, 荣国威. 复杂肱骨近端骨折的手术治疗[J]. 中华骨科杂志, 2005, 25(3):159-164.
13.	Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults:a systematic review of management[J]. Injury, 2001, 32(5):363-372.
14.	Iyengar JJ, Devcic Z, Sproul RC. Nonoperative treatment of proximal humerus fractures:a systematic review[J]. J Orthop Trauma, 2011, 25(10):612-617.
15.	Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate[J]. J Bone Joint Surg Am, 2010, 92(1 Pt 1):85-95.
16.	Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head[J]. J Shoulder Elbow Surg 1998, 7(6):586-590.

1. Palvanen M, Kannus P, Niemi S, et al. Update in the epidemiology of proximal humeral fractures[J]. Clin Orthop Relat Res, 2006, 442(12):87-92.
2. Cadossi M, Mazzotti A, Capra C, et al. Proximal humeral fractures in elderly patients[J]. Aging Clin Exp Res, 2013, 25(1):S85-S87.
3. 魏均强, 张伯勋, 唐佩福, 等. 肱骨近端骨折分型和诊治进展[J]. 中华创伤杂志, 2010, 26(11):1053-1056.
4. Namdari S, Horneff JG, Baldwin K. Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures a systematic review[J]. J Bone Joint Surg Am, 2013, 95(18):1701-1708.
5. Lanting B, Macdermid J, Drosdowech D, et al. Proximal humeral fractures:a systematic review of treatment modalities[J]. J Shoulder Elbow Surg, 2008, 17(1):42-54.
6. Lill H, Josten C. Conservative or operative treatment of humeral head fractures in the elderly?[J]. Chirurg, 2001, 72(11):1224-1234.
7. 袁本祥, 董英海, 刘祖德, 等. 肱骨近端关节囊内骨折的预后判断标准[J]. 中华骨科杂志, 2006, 26(7):464-467.
8. Solberg BD, Moon CN, Franco DP, et al. Surgical treatment of three and four-part proximal humeral fractures[J]. J Bone Joint Surg Am, 2009, 91(7):1689-1697.
9. Foruria AM, De Gracia MM, Larson DR, et al. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures[J]. J Bone Joint Surg Br, 2011, 93(3):378-386.
10. Hertel R, Hempfing A, Stiehler M, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus[J]. J Shoulder Elbow Surg, 2004, 13(4):427-433.
11. 曾浪清, 陈云丰, 唐三元. 不同内侧柱支撑重建对锁定钢板固定治疗肱骨近端骨折的影响[J]. 中华创伤骨科杂志, 2014, 16(1):6-11.
12. 黄强, 王满宜, 荣国威. 复杂肱骨近端骨折的手术治疗[J]. 中华骨科杂志, 2005, 25(3):159-164.
13. Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults:a systematic review of management[J]. Injury, 2001, 32(5):363-372.
14. Iyengar JJ, Devcic Z, Sproul RC. Nonoperative treatment of proximal humerus fractures:a systematic review[J]. J Orthop Trauma, 2011, 25(10):612-617.
15. Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate[J]. J Bone Joint Surg Am, 2010, 92(1 Pt 1):85-95.
16. Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head[J]. J Shoulder Elbow Surg 1998, 7(6):586-590.

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Risk Analysis of Locking Plate for 3-part or 4-part Proximal Humerus Fracture

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