Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 135, Issue 2, pp 235–242 | Cite as

Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis

  • Hyoung Keun Oh
  • Dae Yeon Cho
  • Suk Kyu Choo
  • Jong Woong Park
  • Ki Chul Park
  • Jung Il LeeEmail author
Trauma Surgery

Abstract

Introduction

The authors present clinical and radiographic results of minimal invasive plate osteosynthesis (MIPO) for three- or four-part fractures of the proximal humerus.

Patients and methods

Twenty-six patients with three- or four-part proximal humeral fractures treated with the MIPO technique through the deltoid splitting approach were clinically and radiographically evaluated at a minimum of 12 months with an average of 20.1 months. The valgus-impacted type of three-part fracture was excluded to verify the results of the MIPO with unstable multifragmentary fractures of the proximal humerus.

Results

Twenty female patients and six male patients were included (mean age 67 years; range 18–90 years). No cases of nonunion were seen. The mean forward flexion, abduction, and external rotation were 145°, 119°, and 48°, respectively. The mean visual analog scale (VAS) for pain was 1.47 points. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 14.5 points, and the mean UCLA score was 29.6 points. The mean neck-shaft angle was 134°. Twenty-three patients had adequate medial support, and three patients did not have adequate medial support on initial postoperative radiographs. Five shoulders (19 %) developed complicated results. Two cases of proximal malposition of the plate (7.7 %) and two intra-articular screw penetrations (7.7 %) were observed. One case of osteonecrosis of the humeral head was identified at the final follow-up (3.8 %).

Conclusion

The MIPO technique provides reliable radiologic and functional outcomes for three- and four-part proximal humeral fractures. Our results might support the use of MIPO for treating unstable multi fragmentary fractures of proximal humerus such as three- or four-part fractures to decrease osteonecrosis of humeral head.

Keywords

Humeral fracture Proximal humeral fracture Locking plate fixation Minimal invasive approach Minimal invasive plate osteosynthesis MIPO 

Notes

Acknowledgments

This work was supported by the research fund of Hanyang University (HY-2014).

Conflict of interest

None.

References

  1. 1.
    Ring D (2007) Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury 38(Suppl 3):S59–S68PubMedCrossRefGoogle Scholar
  2. 2.
    Lill H, Hepp P, Rose T et al (2004) The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach technique and first results. Zentralbl Chir 129:43–48PubMedCrossRefGoogle Scholar
  3. 3.
    Laflamme GY, Rouleau DM, Berry GK et al (2008) Percutaneous humeral plating of fractures of the proximal humerus: results of a prospective multicenter clinical trial. J Orthop Trauma 22:153–158PubMedCrossRefGoogle Scholar
  4. 4.
    Roderer G, Erhardt J, Graf M et al (2010) Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma 24:400–406PubMedCrossRefGoogle Scholar
  5. 5.
    Ruchholtz S, Hauk C, Lewan U et al (2011) Minimally invasive polyaxial locking plate fixation of proximal humeral fractures: a prospective study. J Trauma 71:1737–1744PubMedCrossRefGoogle Scholar
  6. 6.
    Jung SW (2013) Indirect reduction maneuver and minimally invasive approach for displaced proximal humerus fractures in elderly patients. Clin Orthop Surg 5:66–73PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Acklin YP, Stoffel K, Sommer C (2013) A prospective analysis of the functional and radiological outcomes of minimally invasive plating in proximal humerus fractures. Injury 44–4:456–460CrossRefGoogle Scholar
  8. 8.
    Sohn HS, Shin SJ (2014) Minimally invasive plate osteosynthesis for proximal humeral fractures: clinical and radiologic outcomes according to fracture type. J Shoulder Elbow Surg 23–9:1334–1340CrossRefGoogle Scholar
  9. 9.
    Gavaskar AS, Muthukumar S, Chowdary N (2010) Biological osteosynthesis of complex proximal humerus fractures: surgical technique and results from a prospective single center trial. Arch Orthop Trauma Surg 130:667–672PubMedCrossRefGoogle Scholar
  10. 10.
    Barco R, Barrientos I, Encinas C et al (2012) Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus. Injury 43(Suppl 2):S7–S11PubMedCrossRefGoogle Scholar
  11. 11.
    Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68:1136–1144PubMedGoogle Scholar
  12. 12.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608PubMedCrossRefGoogle Scholar
  13. 13.
    Paavolainen P, Bjorkenheim JM, Slatis P et al (1983) Operative treatment of severe proximal humeral fractures. Acta Orthop Scand 54:374–379PubMedCrossRefGoogle Scholar
  14. 14.
    Gardner MJ, Weil Y, Barker JU et al (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191PubMedCrossRefGoogle Scholar
  15. 15.
    Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium-2007: orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133PubMedCrossRefGoogle Scholar
  16. 16.
    Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089PubMedGoogle Scholar
  17. 17.
    Aaron D, Shatsky J, Paredes JC et al (2013) Proximal humeral fractures: internal fixation. Instr Course Lect 62:143–154PubMedGoogle Scholar
  18. 18.
    Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7:586–590PubMedCrossRefGoogle Scholar
  19. 19.
    Sturzenegger M, Fornaro E, Jakob RP (1982) Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg 100:249–259PubMedCrossRefGoogle Scholar
  20. 20.
    Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42:408–413PubMedCrossRefGoogle Scholar
  21. 21.
    Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91(7):1689–1697PubMedCrossRefGoogle Scholar
  22. 22.
    Smith J, Berry G, Laflamme Y et al (2007) Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury 38:206–211PubMedCrossRefGoogle Scholar
  23. 23.
    Resch H, Beck E, Bayley I (1995) Reconstruction of the valgus-impacted humeral head fracture. J Shoulder Elbow Surg 4:73–80PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Hyoung Keun Oh
    • 1
  • Dae Yeon Cho
    • 1
  • Suk Kyu Choo
    • 1
  • Jong Woong Park
    • 2
  • Ki Chul Park
    • 3
  • Jung Il Lee
    • 3
    Email author
  1. 1.Department of Orthopedic SurgeryInje University Ilsan Paik HospitalGoyangKorea
  2. 2.Department of Orthopedic SurgeryKorea University Anam HospitalSeoulKorea
  3. 3.Department of Orthopedic SurgeryHanyang University Guri HospitalGuriKorea

Personalised recommendations