Proximal periarticular locking plates in proximal humeral fractures: functional outcomes

• Published in: Journal of shoulder and elbow surgery 2011-12, Vol.20 (8), p.1234-1240
• Main Authors: Schulte, Leah M., MD, Matteini, Lauren E., MD, Neviaser, Robert J., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; ASES; Biological and medical sciences; Bone Plates; Bone Screws; DASH; Diseases of the osteoarticular system; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Healing; Humans; Injuries of the limb. Injuries of the spine; locking plates; Male; Medical sciences; Middle Aged; Orthopedics; Prosthesis Design; Proximal humeral fracture; Radiography; Range of Motion, Articular; Retrospective Studies; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - physiopathology; Shoulder Fractures - surgery; Shoulder Joint - injuries; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Traumas. Diseases due to physical agents; Treatment Outcome; Young Adult
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.12.015

Background Some recent studies have asserted that locking plates do not provide adequate fixation of proximal humeral fractures. The purpose of this study is to review our experience with proximal humeral locking plates, including complications, functional outcomes, and predictors of successful treatment. Materials and methods At our institution, 45 patients (46 shoulders) with displaced proximal humeral fractures were treated with a proximal humeral locking plate over a 6-year period. Patients underwent standard surgical and rehabilitation protocols and were evaluated clinically with Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons standardized outcome measurements and range of motion at last follow-up. Radiographs obtained preoperatively, immediately postoperatively, and at final follow-up were evaluated for fracture type, union, and change in alignment. Results There were 43 patients (44 shoulders) available for range-of-motion and functional outcome measures with an average follow-up of 34 months. Fracture types included 19 two-part, 21 three-part, 3 four-part, and 1 head-splitting fracture. The mean Disabilities of the Arm, Shoulder and Hand score was 11. The average American Shoulder and Elbow Surgeons score was 85. The average visual analog pain score was 0.8. The average range of motion was as follows: elevation, 140°; external rotation at side, 49°; external rotation in abduction, 77°; and internal rotation, T11. No patient had evidence of screw cutout, varus collapse, or avascular necrosis. One patient required hardware removal. Conclusions Displaced proximal humeral fractures can be successfully fixed with locking plates when attention is paid to anatomic reduction, proper plate placement below to the greater tuberosity to allow abduction, screws in the head with subchondral bone purchase, calcar screws from inferior-lateral to superior-medial and delaying shoulder motion until at least 2 weeks.