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Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?

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Clinical Orthopaedics and Related Research®

Abstract

The optimal surgical treatment of displaced proximal humeral fractures is controversial. New implants providing angular stability have been introduced to maintain the intraoperative reduction. In a multi-institutional study, we prospectively enrolled and followed 152 patients with unilateral displaced and unstable proximal humeral fractures treated either with an antegrade angular and sliding stable proximal interlocking nail or an angular stable plate. Fractures were classified according to the Neer four-segment classification. Clinical, functional, and radiographic followups were performed 3, 6, and 12 months after surgery. Absolute and relative (to the contralateral shoulder) Constant-Murley scores were used to assess postoperative shoulder function. Using age, gender, and fracture type, we identified 76 pairs (152 patients) for a matched-pairs analysis. Relative Constant-Murley scores 12 months after treatment with an angular and sliding stable nail and after plate fixation were 81% and 77%, respectively. We observed no differences between the two groups. Stabilization of displaced proximal humeral fractures with either an angular stable intramedullary or an extramedullary implant seems suitable with both surgical treatment options.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Adedapo AO, Ikpeme JO. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury. 2001;32:115–121.

    Article  PubMed  CAS  Google Scholar 

  2. Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741–745.

    Article  PubMed  Google Scholar 

  3. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.

    PubMed  Google Scholar 

  4. Dimakopoulos P, Panagopoulos A, Kasimatis G. Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am. 2009;91:8–21.

    Article  PubMed  Google Scholar 

  5. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.

    Article  PubMed  Google Scholar 

  6. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.

    Article  PubMed  Google Scholar 

  7. Gardner MJ, Griffith MH, Dines JS, Lorich D. A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis. 2004;62:18–23.

    PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  9. Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–845.

    Article  Google Scholar 

  10. Gierer P, Simon C, Gradl G, Ewert A, Vasarhelyi A, Beck M, Mittlmeier T. [Complex proximal humerus fractures: management with a humeral head prosthesis?] [in German]. Orthopäde. 2006;35:834–840.

    Article  PubMed  CAS  Google Scholar 

  11. Gilchrist DK. A Stockinette-Vaelpeau for immobilization of the shoulder girdle. J Bone Joint Surg Am. 1967;49:750–751.

    PubMed  CAS  Google Scholar 

  12. Gradl G, Dietze A, Arndt D, Beck M, Gierer P, Börsch T, Mittlmeier T. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:937–944.

    Article  PubMed  Google Scholar 

  13. Habermeyer P. [Fracture of the head of the humerus] [in German]. Unfallchirurg. 1997;100:820–837.

    Article  PubMed  CAS  Google Scholar 

  14. Hessler C, Schmucker U, Matthes G, Ekkernkamp A, Gütschow R, Eggers C. [Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate] [in German]. Unfallchirurg. 2006;109:867–874.

    Article  PubMed  CAS  Google Scholar 

  15. Hessmann MH, Blum J, Hofmann A, Küchle R, Rommens PM. Internal fixation of proximal humeral fractures: current concepts. Eur J Trauma. 2003;29:253–261.

    Article  Google Scholar 

  16. Hessmann MH, Hansen WS, Krummenauer F, Rommens PM. Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma. 2005;58:1194–1201.

    Article  PubMed  Google Scholar 

  17. Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82:1107–1112.

    Article  PubMed  CAS  Google Scholar 

  18. Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate: presentation of 225 cases of dislocated fractures] [in German]. Unfallchirurg. 2006;109:1032–1040.

    Article  PubMed  CAS  Google Scholar 

  19. Kollig E, Kutscha-Lissberg F, Roetman B, Mielke E, Muhr G, Hahn MP. [Primary hemiarthroplasty after complex fracture of the humeral head: functional late results] [in German]. Zentralbl Chir. 2003;128:125–130.

    Article  PubMed  CAS  Google Scholar 

  20. Krivohlavek M, Lukas R, Taller S, Sram J. [Use of angle-stable implants for proximal humeral fractures: prospective study] [in Czech]. Acta Chir Orthop Traumatol Cech. 2008;75:212–220.

    PubMed  CAS  Google Scholar 

  21. Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg. 2003;123:74–81.

    PubMed  CAS  Google Scholar 

  22. Lill H, Hepp P, Rose T, König K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach: technique and first results] [in German]. Zentralbl Chir. 2004;129:43–48.

    Article  PubMed  CAS  Google Scholar 

  23. Lill H, Josten C. [Conservative or operative treatment of humeral head fractures in the elderly?] [in German]. Chirurg. 2001;72:1224–1234.

    Article  PubMed  CAS  Google Scholar 

  24. Mathews J, Lobenhoffer P. [The Targon® PH Nail as an internal fixator for unstable fractures of the proximal humerus] [in German]. Oper Orthop Traumatol. 2007;19:255–275.

    Article  PubMed  Google Scholar 

  25. Mittlmeier TW, Stedtfeld HW, Ewert A, Beck M, Frosch B, Gradl G. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon-PH). J Bone Joint Surg Am. 2003;85(suppl 2):136–146.

    PubMed  Google Scholar 

  26. Neer CS. Displaced proximal humeral fractures. II. Treatment of three part and four part displacement. J Bone Joint Surg Am. 1970;52:1090–1103.

    PubMed  Google Scholar 

  27. Neer CS. Four-segment classification of proximal humeral fractures. J Shoulder Elbow Surg. 2002;11:389–400.

    Article  PubMed  Google Scholar 

  28. Phillips B, Ball C, Sackett D, Badenoch D, Straus D, Haynes B, Dawes. Levels of evidence and grades of recommendation. Oxford, UK: Oxford-Centre for Evidence Based Medicine; 2001. Available at: http://www.cebm.net/levels_of_evidence.asp. Accessed February 13, 2009.

  29. Resch H. [Fractures of the humeral head] [in German]. Unfallchirurg. 2003;106:602–617.

    Article  PubMed  CAS  Google Scholar 

  30. Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.

    Article  PubMed  CAS  Google Scholar 

  31. Sonderegger J, Simmen HP. [Epidemiology treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area] [in German]. Zentralbl Chir. 2003;128:119-124.

    Article  PubMed  CAS  Google Scholar 

  32. Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B. [Fixation of humeral head fractures with antegrade intramedullary nailing] [in German]. Zentralbl Chir. 2003;128:6–11.

    Article  PubMed  Google Scholar 

  33. Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: tips and tricks. Eur J Trauma Emerg Surg. 2007;4:367–374.

    Article  Google Scholar 

  34. Tamai K, Ohno W, Takemura M, Mashitori H, Hamada J, Saotome K. Treatment of proximal humeral fractures with an intramedullary nail. J Orthop Sci. 2005;10:180–186.

    Article  PubMed  Google Scholar 

  35. Wijgman AJ, Roolker W, Patt T, Raaymakers E, Marti R. Open reduction internal fixation of three and four part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.

    PubMed  Google Scholar 

  36. Zyto K, Kronberg M, Brostrom LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 1995;4:331–336.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Helga Krentz, Institute of Biostatistics, University of Rostock, for assistance in the statistical data analysis.

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Correspondence to A. Dietze MD.

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This work was performed at University of Rostock and the Campus Virchow and Campus Benjamin Franklin of Humboldt University.

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Gradl, G., Dietze, A., Kääb, M. et al. Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?. Clin Orthop Relat Res 467, 2986–2993 (2009). https://doi.org/10.1007/s11999-009-0916-5

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  • DOI: https://doi.org/10.1007/s11999-009-0916-5

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