Abstract
Aim:
We aimed to evaluate functional and radiographic outcomes of patients with proximal humeral fractures treated with proximal anatomic locking plate and were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification.
Methods:
In this study we included 29 patients (13 females, 16 males) aged 16-82 years who were treated with proximal anatomic locking plate between February 2010 and July 2014. The mean follow up time was 17.76±8.31 months. The right shoulder was operated in 20 patients and the left shoulder in nine patients. Functional outcomes were assessed using the Constant-Murley and University of California at Los Angeles (UCLA) shoulder score and radiologic outcomes were assessed using anteroposterior radyograph.
Results:
At the final follow up, the mean Constant-Murley score was 75.48±18.69. The result was poor in 31.0% (n=9), moderate in 24.1% (n=7), 13.8% (n=4) good and excellent in 31.0% (n=9) of patients. The mean UCLA score was 30.10±5.73. The outcome was poor in 17.2% (n=5), good in 31.0% (n=9) and excellent in 51.7% (n=15) of patients. In 21 patients there were no complications, but complications occurred in eight. When we compared the patients per age groups (<65 and >65), there was no difference in collo-diaphyseal angle (p=0,097, p>0,05), but the Constant-Murley scores (p=0,001) and UCLA scores (p=0,01) were statistically higher in patients below 65 years of age than in those above 65 years.
Conclusion:
Treathment with proximal anatomic locking plate is preferred since it supports early motion and leads to good functional results in partial proximal humeral fractures.
Keywords: Proximal humeral fractures, locking anatomic plate, AO/OTA classification
References
Vijayvargia M, Pathak A, Gaur S. Outcome analysis of Locking Plate Fixation in Proximal Humerus Fracture. J Clin Diagn Res 2016;10:RC01-5.
Egol KA, Ong CC, Walsh M, Jazrawi L, Tejwani N, Zuckerman JD. Early Complications in Proximal Humerus Fractures (OTA Types 11) Treated With Locked Plates. J Orthop Trauma 2008;22:159-64.
Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 1989;108:285-7.
Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduktion and internal fiksation of the three and four part fractures of the proximal humerus. J Bone Joint Surg Am 2002;84:1919-25.
Iannotti JP, Ramsey ML, Williams GR, Warner JJP. Nonprosthetic management of proximal humeral fractures. J Bone Joint Surg Am 2003;85:1578-93.
Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium. Acta Orthop Scand 2000;71:465-70.
Rees J, Hicks J, Ribbans W. Assesment and management of three and four part proximal humerus fractures. Clin Orthop Relat Res 1998;353:18-29.
Rajesekhar C, Ray PS, Bhamra MS. Fixation of proximal humeral fractures with the polarus nail. J Shoulder Elbow Surg 2001;10:7-10.
Helfen T, Siebenburger G, Mayer M, Bocker W, Ockert B, Haasters F. Operative treathment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate PHILOSTM vs. proximal humerus nail MultiLoc®. BMC Musculoskeletal Disorders 2016;17:1-7.
Burke NG, Kennedy J, Cousins G, Fitzpatrick D, Mullet H. Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg 2014;22:190-4.
Neer CS, Four-segment classification of proksimal humeral fractures: Purpose and reliable use. J Shoulder Elbow Surg 2002;11(4):389-400.
Neer CS, Shoulder reconstruction. Philedelphia WB Saunders, 1990.
Zyato K, Ahrengart L, Sperber A, Törnkvist H. Treatment of displaced proximal humerus fractures in elderly patients. J Bone Joint Surg Br 1997;79:412-7.
Kayalar M, Toros T, Bal E, Özaksar K, Gürbüz Y, Ademoğlu Y. Proksimal humerus kırıklarında perkütan tespit için hasta seçiminin önemi. Acta Orthop Traumatol Turc 2007;43:35-41.
Agudelo JF, Shürmann M, Stahel P, et al. Analysis of efficacy and failure in proximal humerus fractures threated with angular stable locking plates. J Orthop Trauma 2007;21:676-81.
Koukakis A, Apostolou CD, Taneja T, Korres DS, Amina A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res 2006;(442):115-20.
Korkmaz MF, Aksu N, Göğüş A, Debre M, Kara AN, Işıklar ZU. Proksimal humerus kırıklarında kilitli plak PHILOS ile internal tespit sonuçları, Acta Orthop Traumatol Turc 2008;42:97-105.
Atalar AC, Demirhan M, Uysal M, Seyahi A. Treatment of Neer type 4 impacted valgus fractures of the proximal humerus with open reduction, elevation and grafting. [Article in Turkish] Acta Orthop Traumatol Turc 2007;41:113-9.
Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect Medial Reduction and Strut Support of Proximal Humerus Fractures Using an Endosteal Implant. J Orthop Trauma 2008;22:195-200.
Parmaksizoğlu AS, Sökücü S, Özkaya U, Kabukçuoğlu Y, Gül M. Locking plate fixation of three- and four-part proximal humeral fractures. Acta Orthop Traumatol Turc 2010;44:97-104.
Rodop O, Kıral A, Akmaz İ, Arpacıoğlu MÖ, Şanel S, Kaplan H. Yaşlı hastalarda deplase parçalı eklem içi proksimal humerus kırıklarında primer hemiartroplasti uygulamalar-ımızın erken sonuçları. The Journal of Arthroplasty 2002;13:78-84.
Kılıç B, Uysal M, Çınar BM, Özkoç G, Demirörs H, Akpınar S. Early results of treatment of proximal humerus fractures with the PHILOS locking plate; Acta Orthop Traumatol Turc 2008;42:149-53.
U.S Preventive Services Task Force. Screening for osteoporosis: U. S. preventive services task force recommendation statement. Ann Intern Med 2011;154:356-64.
