The plate fixation strategy of complex proximal humeral fractures
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REVIEW ARTICLE
The plate fixation strategy of complex proximal humeral fractures Qi Sun 1 & Xiaoming Wu 2 & Lei Wang 3 & Ming Cai 1 Received: 20 February 2020 / Accepted: 18 March 2020 # SICOT aisbl 2020
Abstract Purpose For complex proximal humeral fractures, severe displacement and comminuted fragments lead to poor clinical outcomes. Despite considerable management, the locking plate fixation is still a preference and the proper selection of its strategy for each individual seems to be essential. Method The available classification system of the fracture, determination of surgical intervention, the common complications and related causes, and the latest critical surgical strategies with locking plate fixation were discussed in this review. Results The frequent complications with complex proximal humeral fractures after operative treatment present a great challenge to orthopedic surgeons. In order to maintain the stability of locking plate fixation, several options including calcar screw, bone graft, bone cement augmentation, dual plate fixation, and fracture impaction were available for restoration of medial support. Conclusion Restoration of medial support seems of importance to provide solid stability and reduced complication for the complex fractures with fixation of locking plates. Keywords Proximal humeral fractures . Plate fixation . Medial support
Introduction Proximal humeral fractures (PHF) are seen most commonly in aged population, accounting for 4 to 9% of all fractures in adults [1]. The overall incidence considerably increased in the elderly population, particularly in the elderly over 65 years old [2]. The incidence of complex fractures types is usually positively associated with increasing age. The mechanism of PHF is largely attributed to low-energy fall, especially in the elderly population [3]. That is partly due to the decreased bone quality and mobility of the elderly.
Qi Sun and Xiaoming Wu contributed equally to this work. * Lei Wang [email protected] * Ming Cai [email protected] 1
Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
2
Department of Orthopedics, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
3
Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
The majority of PHF are either nondisplaced or minimally displaced, which are usually treated with conservative management [4, 5]. Various surgical techniques of open or closed reduction and internal fixation were applied for displaced and unstable PHF. Compared with conservative management, surgical treatment of displaced unstable fractures yields relatively satisfactory clinical results, especially for functionally active patients. The surgical treatment of PHF is expected to up to 20%, due to potential complications with conservative treatment in an aging population [6]. Currently, the treat
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