Skip to main content

Advertisement

SpringerLink
Log in

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objectives

We report early results using a second generation locking plate, non-contact bridging plate (NCB PH®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability.

Design

Prospective case series.

Setting

A single level-1 trauma center.

Patients

A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005.

Intervention

Surgery was performed in open technique in all cases.

Main outcome measures

Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant–Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks.

Results

All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76.

Conclusions

The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH® is a safe implant for the treatment of proximal humeral fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bathis H, Tingart M, Bouillon B, Tiling T (2001) Surgical treatment of proximal humeral fractures. Is the T-plate still adequate osteosynthesis procedure? Zentralbl Chir 126(3):211–216. doi:10.1055/s-2001-12498

    Article  PubMed  CAS  Google Scholar 

  2. Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, Marynissen H (2007) Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127(3):205–210. doi:10.1007/s00402-006-0256-9

    Article  PubMed  CAS  Google Scholar 

  3. Constant CR (1997) An evaluation of the Constant–Murley shoulder assessment. J Bone Joint Surg Br 79(4):695–696

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  5. Edwards SL, Wilson NA, Zhang LQ, Flores S, Merk BR (2006) Two-part surgical neck fractures of the proximal part of the humerus. A biomechanical evaluation of two fixation techniques. J Bone Joint Surg Am 88(10):2258–2264. doi:10.2106/JBJS.E.00757

    Article  PubMed  Google Scholar 

  6. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res 430:176–181. doi:10.1097/01.blo.0000137554.91189.a9

    Article  PubMed  Google Scholar 

  7. Gardner MJ, Griffith MH, Demetrakopoulos D, Brophy RH, Grose A, Helfet DL, Lorich DG (2006) Hybrid locked plating of osteoporotic fractures of the humerus. J Bone Joint Surg Am 88(9):1962–1967. doi:10.2106/JBJS.E.00893

    Article  PubMed  Google Scholar 

  8. Gardner MJ, Voos JE, Wanich T, Helfet DL, Lorich DG (2006) Vascular implications of minimally invasive plating of proximal humerus fractures. J Orthop Trauma 20(9):602–607. doi:10.1097/01.bot.0000246412.10176.14

    Article  PubMed  Google Scholar 

  9. Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21(3):185–191. doi:10.1097/BOT.0b013e3180333094

    Article  PubMed  Google Scholar 

  10. Helmy N, Hintermann B (2006) New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res 442:100–108. doi:10.1097/01.blo.0000194674.56764.c0

    Article  PubMed  Google Scholar 

  11. Hente R, Kampshoff J, Kinner B, Fuchtmeier B, Nerlich M (2004) Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate. Unfallchirurg 107(9):769–782. doi:10.1007/s00113-004-0818-7

    Article  PubMed  CAS  Google Scholar 

  12. Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16(Suppl 2):S65–S72. doi:10.1007/s00198-004-1714-2

    Article  PubMed  Google Scholar 

  13. Hessmann M, Baumgaertel F, Gehling H, Klingelhoeffer I, Gotzen L (1999) Plate fixation of proximal humeral fractures with indirect reduction: surgical technique and results utilizing three shoulder scores. Injury 30(7):453–462. doi:10.1016/S0020-1383(99)00111-4

    Article  PubMed  CAS  Google Scholar 

  14. Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR (2005) Normalization of the Constant score. J Shoulder Elbow Surg 14(3):279–285. doi:10.1016/j.jse.2004.10.009

    Article  PubMed  Google Scholar 

  15. Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W (2006) Treatment of proximal humeral fractures with the PHILOS angular stable plate: presentation of 225 cases of dislocated fractures. Unfallchirurg 109(12):1032–1040. doi:10.1007/s00113-006-1165-7

    Article  PubMed  CAS  Google Scholar 

  16. Lee SH, Dargent-Molina P, Breart G (2002) Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 17(5):817–825. doi:10.1359/jbmr.2002.17.5.817

    Article  PubMed  Google Scholar 

  17. Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123(2–3):74–81

    PubMed  CAS  Google Scholar 

  18. Meier RA, Messmer P, Regazzoni P, Rothfischer W, Gross T (2006) Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate. J Orthop Trauma 20(4):253–260. doi:10.1097/00005131-200604000-00004

    Article  PubMed  Google Scholar 

  19. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92. doi:10.1097/01.blo.0000194672.79634.78

    Article  PubMed  Google Scholar 

  20. Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17(1):25–50. doi:10.1007/s00064-005-1120-8

    Article  PubMed  Google Scholar 

  21. Ring D (2007) Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury 38(Suppl 3):S59–S68. doi:10.1016/j.injury.2007.08.013

    Article  PubMed  Google Scholar 

  22. Robinson CM, Page RS (2004) Severely impacted valgus proximal humeral fractures. J Bone Joint Surg Am 86-A(Suppl 1(Pt 2)):143–155

    PubMed  Google Scholar 

  23. Roderer G, Gebhard F, Erhardt J, Abouelsoud M, Kinzl L (2007) The non-contact bridging plate: a new fixed-angle device for the minimally-invasive treatment of fractures of the proximal humerus—technique and preliminary results. Unfallchirurg 110(6):505–512

    Article  PubMed  CAS  Google Scholar 

  24. Seide K, Triebe J, Faschingbauer M, Schulz AP, Puschel K, Mehrtens G, Jurgens C (2007) Locked vs. unlocked plate osteosynthesis of the proximal humerus—a biomechanical study. Clin Biomech (Bristol, Avon) 22(2):176–182. doi:10.1016/j.clinbiomech.2006.08.009

    Article  CAS  Google Scholar 

  25. Vallier HA (2007) Treatment of proximal humerus fractures. J Orthop Trauma 21(7):469–476. doi:10.1097/BOT.0b013e318133479c

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Orthopädische Chirurgie, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Johannes B. Erhardt, K. Grob, T. N. Forster & M. S. Kuster

  2. Fremantle Orthopaedic Unit, The University of Western Australia, Perth, WA, Australia

    Johannes B. Erhardt, K. Stoffel & M. S. Kuster

  3. Abteilung für Unfallchirurgie, Universitätsklinik Ulm, Ulm, Germany

    G. Roderer

Authors
  1. Johannes B. Erhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Roderer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Grob
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. N. Forster
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Stoffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. S. Kuster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes B. Erhardt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erhardt, J.B., Roderer, G., Grob, K. et al. Early results in the treatment of proximal humeral fractures with a polyaxial locking plate. Arch Orthop Trauma Surg 129, 1367–1374 (2009). https://doi.org/10.1007/s00402-009-0924-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-009-0924-7

Keywords

Search

Navigation