Vantaggi e limiti del trattamento con placche a stabilità angolare delle fratture complesse a 3–4 parti dell’epifisi prossimale dell’omero

Abstract

Open reduction and internal fixation (ORIF) with angular stable plates have been developed to obtain stronger anchorage, even in osteoporotic bone, and avoid loss of reduction, screw loosening, malunion and osteonecrosis. In most cases, internal fixation with locking proximal plates can lead to a good functional outcome but, in recent series and in our experience, the incidence of complications, mainly in some patterns of fractures (3–4 part varus fractures with medial calcar comminution and instability or multifragmented valgus fractures in osteoporotic bone), suggests that some technical considerations about fracture reduction, correct use of different models of locking plates, careful attention to the reconstruction of the medial metaphyseal wall and a wider use of central bone graft or solid bone substitute could decrease the rate of failures of this technique.