Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Ring D (2007) Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury 38(Suppl 3):S59–S68

    PubMed  Article  Google Scholar 

  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 129:43–48

    CAS  PubMed  Article  Google Scholar 

  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 22:153–158

    PubMed  Article  Google Scholar 

  4. Roderer G, Erhardt J, Graf M et al (2010) Clinical results for minimally invasive locked plating of proximal humerus fractures. J Orthop Trauma 24:400–406

    PubMed  Article  Google Scholar 

  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 71:1737–1744

    PubMed  Article  Google Scholar 

  6. Jung SW (2013) Indirect reduction maneuver and minimally invasive approach for displaced proximal humerus fractures in elderly patients. Clin Orthop Surg 5:66–73

    PubMed Central  PubMed  Article  Google Scholar 

  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 44–4:456–460

    Article  Google Scholar 

  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 23–9:1334–1340

    Article  Google Scholar 

  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 130:667–672

    PubMed  Article  Google Scholar 

  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–S11

    PubMed  Article  Google Scholar 

  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 68:1136–1144

    CAS  PubMed  Google Scholar 

  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 29:602–608

    CAS  PubMed  Article  Google Scholar 

  13. Paavolainen P, Bjorkenheim JM, Slatis P et al (1983) Operative treatment of severe proximal humeral fractures. Acta Orthop Scand 54:374–379

    CAS  PubMed  Article  Google Scholar 

  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 21:185–191

    PubMed  Article  Google Scholar 

  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–S133

    CAS  PubMed  Article  Google Scholar 

  16. Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    PubMed  Google Scholar 

  17. Aaron D, Shatsky J, Paredes JC et al (2013) Proximal humeral fractures: internal fixation. Instr Course Lect 62:143–154

    PubMed  Google Scholar 

  18. Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7:586–590

    CAS  PubMed  Article  Google Scholar 

  19. Sturzenegger M, Fornaro E, Jakob RP (1982) Results of surgical treatment of multifragmented fractures of the humeral head. Arch Orthop Trauma Surg 100:249–259

    CAS  PubMed  Article  Google Scholar 

  20. Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42:408–413

    PubMed  Article  Google Scholar 

  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):1689–1697

    PubMed  Article  Google Scholar 

  22. Smith J, Berry G, Laflamme Y et al (2007) Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury 38:206–211

    PubMed  Article  Google Scholar 

  23. Resch H, Beck E, Bayley I (1995) Reconstruction of the valgus-impacted humeral head fracture. J Shoulder Elbow Surg 4:73–80

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgments

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

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jung Il Lee.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Oh, H.K., Cho, D.Y., Choo, S.K. et al. Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis. Arch Orthop Trauma Surg 135, 235–242 (2015). https://doi.org/10.1007/s00402-014-2138-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2138-x

Keywords

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