Why locking plates for the proximal humerus do not fit well
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TRAUMA SURGERY
Why locking plates for the proximal humerus do not fit well Hyungsuk Kim1 · Yang‑Guk Chung2 · Ji Seok Jang1 · Yongdeok Kim1 · Soo Bin Park1 · Hyun Seok Song1 Received: 13 April 2020 / Accepted: 28 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction We compared the angle of the humerus and plate and to assess compatibility of a plate to the proximal humerus using three-dimensional (3D) printed models. Materials and methods A total of 120 cases were included, who underwent anteroposterior shoulder radiographs. From these, 30 cases with 3D shoulder computed tomography scans were randomly selected to print 3D model. The lateral angle between the lateral cortex of the humeral shaft and lateral border of the greater tuberosity (GT), neck-shaft angle, and height from the most proximal point of the GT to the angular point were measured. When the plates were applied on the 3D models, the gap from the most proximal point of the GT to the proximal rim of the plate was measured. Results The mean lateral angle in plain radiographs was 12.9 ± 2.2° and height from the most proximal point of the GT to the angular point was 44.4 ± 4.7 mm. The bending angles of the three plates were 8° and 10°. Height from the proximal rim of the plate to the bending point was 42.4, 42.0 and 43.8 mm. In 98% of cases, the lateral angle of the humerus was larger than all three plates. In 43% of cases, height of the GT was smaller than height of plates. When plates were applied to the 3D model, the mean gap from GT to plate was 4.8 ± 2.8 mm. Conclusions There was large variation in the lateral angle of the proximal humerus, which was not correlated with the neckshaft angle. The lateral angle of the humerus was larger than the plates and prone to varus reduction and medial collapse. Level of evidence or clinical relevance Basic science study. Keywords Proximal humeral fracture · Locking plate · Compatibility · 3D printing
Introduction Stable and minimally displaced fractures of the proximal humerus are treated non-operatively with short term immobilization, showing good clinical results [1, 2]. However, complex fractures with severe displacement and comminution are difficult to treat and are becoming more common due to osteoporosis in an aging society with comorbidities [3, 4]. Surgical treatment of the proximal humeral fracture includes plate fixation, percutaneous pinning,
* Hyun Seok Song [email protected] 1
Department of Orthopedic Surgery, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, 1021 Tongil‑ro, Eunpyeong‑gu, Seoul 03312, Republic of Korea
College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
2
hemiarthroplasty, and reverse total shoulder arthroplasty [5–10]. For osteoporotic proximal humeral fractures, locking plate fixation is commonly used [1, 6, 11]. Locking screws provide stability to the fracture and angular stability with higher resistance to failure [4, 12, 13]. Nevertheless
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