Open Reduction and Internal Fixation of Proximal Humerus Fractures with a Cannulated Blade Plate

Abstract

Objective

Internal fixation of proximal humerus fractures with an implant assuring rotational and angular stability to restore form and function of the glenohumeral joint.

Indications

Proximal humerus fractures: two- and three-part fractures, meta- and diaphyseal fractures of the proximal second fifth.

Contraindications

Comminuted fractures of the humeral head.

Proximal humerus fractures in children.

Surgical Technique

Anterior approach. Blunt dissection of the deltopectoral interval, retracting the cephalic vein medially. Judicious exposure of the fracture site and reduction of the fracture. A 90° blade plate opened up to 110–120° is inserted from anterolateral immediately proximal to or through the subcapital fracture gap. The blade of the blade plate is introduced into the proximal half of the humeral head. In the presence of an avulsion of the greater tuberosity, a wire cerclage is added.

Results

Between June 1998 and December 1999, we treated 20 patients (eight men, twelve women, age 65–92 years) and assessed them prospectively. All fractures were closes (AO types 11-A3 n = 8, 11-B1 n = 5, 11-B2 n = 3, 11-B3 n = 1, and 11-C2 n = 3). Loosening of plates was seen in three patients and a blade perforation in one, all requiring a revision (revision with plate blade twice, shoulder hemiarthroplasty once, early implant removal once). Five patients passed away, and two were too old to undergo a follow-up examination. The Constant score in 13 patients performed after 8 (7–10) months reached 62/100 (opposite shoulder 92/100). This corresponds to a satisfactory outcome.