Use of locking plates in the treatment of proximal humerus fractures

Abstract

Open reduction and internal fixation (ORIF) using locked plating has demonstrated promise in the treatment of displaced proximal humerus fractures. The purpose of this article is to describe the surgical technique and to report early clinical results with this technique. Important surgical principles to follow include adequate use of locking screws in the humeral head, bone graft or bone graft substitutes when needed, rotator cuff sutures to assist with reduction and augment fixation, and sufficient use of intraoperative fluoroscopic imaging. A review was performed to evaluate early outcomes of ORIF with proximal humerus locking plates. All cases were fixed with the described surgical technique. Postoperative assessment included radiographic imaging, PENN/ASES Shoulder Scores, range-of-motion (ROM), and complications. Fifty-two patients (54 shoulders) had minimum 6-month follow-up (13-month mean follow-up). Mean age was 65.5 years. Postoperatively, mean active forward elevation was 130.1 degrees, and mean active external rotation was 27.7 degrees. Mean post-op PENN shoulder score was 68.9 and mean post-op ASES score was 70.8. There were 11 (20.4%) complications in 10 (18.5%) shoulders after treatment with a proximal humerus locking plate. Three complications were classified as minor (5.6%), 8 as major (14.8%). Two shoulders (3.7%) required reoperation to address the complications. The use of locking plates in the treatment of displaced proximal humerus fractures is becoming more widespread. With precise knowledge of and experience with the surgical technique, locked plating can be performed safely with good results. However, surgeons should be aware that complications can arise.