Locking Plate Fixation Research Articles

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Proximal Humerus Fracture Treated with Locking Plate Fixation and Fibula Autograft: Case Report

Radiological and Functional Consequences of Open Reduction Internal Fixation with Locking Plate Versus Dynamic Condylar Screw in Type C1 Complete Articular Fracture of Distal Femur

Background: One of the body's main joints for bearing weight is the knee. Its issues are likewise difficult to resolve. Damage to this joint can cause abnormalities in the alignment, stability, and motion of the knee, which impairs function. Objective: To compare the functional and radiological outcome in AO type C1 distal femur fractures fixed with locking plate versus dynamic condylar screw. Methods: The study comprised 94 patients aged 18 to 60 years who had an isolated distal femur fracture and an Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C1 closed fracture. Patients with diabetes mellitus, chronic renal disease, chronic liver disease, ischemic heart disease, pathological fractures, head injuries with a Glasgow coma scale of less than 14, and malignancy were excluded from the sample. The patients were assigned by lottery to groups A and B. In groups A and B, they were treated with dynamic condylar screws (DCS) and locking plate fixation, respectively.. Results: Among 94 patients, 30 (63.8%) were men and 17 (36.2%) were women in Group A; similarly, 33 (70.2%) were men and 14 (29.8%) were women in Group B. Patients in group A had an average age of 38.8±6.19 years, whereas those in group B had an average age of 39.5±7.36 years. 02 patients (4.2%) in Group-A and 05 patients (10.6%) in Group-B experienced infection. The union rate was 45 (95.7%) in group A (locking plate fixation technique) and 40 (85.10%) in group B (dynamic condylar screw technique). 35 (74.46%) in group A, 08 (17.1%) in good, 03 (6.38%) in average, and 01 (2.1%) in poor; in group B, 25 (53.2%) in excellent, 09 (19.2%) in decent, and 10 (21.3%) had average and 03(6.3%) had poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, the type C1 distal shaft femur fixation with locking plate performs better than the dynamic condylar screw, which has a lower infection rate and better union and functional success

Describing the Anatomic Variability of the Dorsal Sulcus of the Distal Radius

Objectives Dorsal extensor tendon rupture is a known complication of volar locking plate fixation for treating distal radius fractures. Tenosynovitis or even tendon rupture secondary to dorsal screw protrusion has been reported in numerous case studies. The high anatomic variability in this area, along with difficulty in imaging the necessary anatomic detail, leads to inaccurate screw measurements. A detailed understanding of the dorsal anatomy of the distal radius may reduce future events. The purpose of this study is to describe a dorsal ulnar sulcus of the distal radius that can hide dorsal screw penetration and thus act as a blind spot to standard oblique radiographic images. Methods After obtaining approval from our Institutional Review Board, 59 consecutive magnetic resonance images of different wrists were analyzed. Using the axial cut with the maximum sulcus depth, a line was drawn from the apex of Lister’s tubercle to the dorsal ulnar corner of the radius. A perpendicular line was then drawn from this line to the deepest point in the sulcus. This measurement was recorded as sulcus depth. Results A sulcus was found in 97% (57/59) of individuals with an average depth of 1.3mm. The sulcus measured greater or equal to 2mm in 14% (8/59) of the wrists studied. The radiocarpal joint averaged 6.1 ± 2.9 mm distal to the sulcus measurement location. There was no significant difference between gender or extremity side regarding sulcus depth. Conclusion The dorsal ulnar blind spot is a clinically relevant sulcus on the dorsum of the distal radius. This region demonstrated variable depth in our study and is not easily quantified using standard radiographs. With heightened awareness of the anatomic variability of the dorsal sulcus, we reduced the incidence of dorsal tendon irritation at our institution to 0%. Therefore, caution should be taken when placing volar screws to prevent dorsal cortex penetration and subsequent extensor tendon injury. Level of Evidence 4

Distal radius fracture osteosynthesis by volar locking plate: influence of epiphyseal screw positioning on risk of loss of reduction

Ulnar variance is an important radiological parameter for good functional outcome after distal radius fracture osteosynthesis. Secondary loss of reduction due to radial shortening is a common complication after volar locking plate fixation. Some authors recommend beginning by placing the most ulnar epiphyseal screw, ensuring that it is positioned as close as possible to the distal radioulnar and radiocarpal joints. The hypothesis of our study was that the positioning of the ulnar epiphyseal screw relative to the distal radioulnar and radiocarpal joints influences the maintenance of reduction during follow-up.190 distal radius fractures were treated with volar locking plate fixation and divided into two cohorts: cohort A with <2 mm and cohort B with ≥2 mm loss of ulnar variance. Minimum follow-up was 45 days. The positioning of the most ulnar epiphyseal screw was evaluated using a single variable, the ulno-distal index. Means were compared using t-tests and proportions using chi-squared tests. The alpha risk was set at 5%. The intra- and inter-observer reliability of the ulno-distal index measurement were assessed.Mean ulno-distal index was significantly lower in cohort A at 11.28 mm, compared to 13.33 mm in cohort B; p < 0.0001. Ulno-distal index <12 mm was a significant protective factor: p < 0.0001 and relative risk 0.558. No other intrinsic or extrinsic factors of secondary loss of reduction significantly influenced the risk of ulnar variance alteration.The study confirmed the hypothesis that, in distal radius fracture treated with volar locking plate fixation, the closer the ulnar epiphyseal screw to the distal radioulnar joint and radiocarpal joint, the lower the risk of ulnar variance alteration.

Current Concepts in Management of Distal Femur Fractures

Recent studies report the overall incidence of distal femur fractures as 8.7/100,000/year. This incidence is expected to rise with high energy motor vehicle collisions and elderly osteoporotic fractures in native and prosthetic knees keep increasing. These fractures are more common in males in the younger age spectrum while females predominate for elderly osteoporotic fractures. Surgical treatment is recommended for these fractures to maintain articular congruity, enable early joint motion and assisted ambulation. Over the last two decades, development of minimally invasive and quadriceps sparing surgical approaches, availability of angle stable implants have helped achieve predictable healing and early return to function in these patients. Currently, laterally positioned locked plate is the implant of choice across all fracture patterns. Retrograde with capital implantation of intramedullary nails with provision for multiplanar distal locking is preferred for extra-articular and partial articular fractures. Even with these advancements, nonunion after distal femur fracture fixation can be as high as 19%. Further recent research has helped us understand the biomechanical limitations and healing problems with lateral locked plate fixation and intramedullary nails. This has lead to development of more robust constructs such as nail-plate and double plate constructs aiming for improved construct strength and to minimise failures. Early results with these combination constructs have shown promise in high risk situations such as fractures with extensive metaphyseal fragmentation, osteoporosis and periprosthetic fractures. These constructs however, run the risk of being over stiff and can inhibit healing if not kept balanced. The ideal stiffness that is needed for fracture healing is not clearly known and current research in this domain has lead to the development of smart implants which are expected to evolve and may help improve clinical results in future.

Outcomes of Autologous and Synthetic Bone Grafts in Locking Plate Fixation of Comminuted Distal Radius Fractures.

Background The introduction of locking plate technology has improved the feasibility of distal radius fracture fixation without the need for bone grafting, yet challenges persist in cases of severely comminuted fractures and small, unstable intra-articular fragments. This study aimed to assess the outcomes of bone grafting in severely comminuted distal radius fractures treated with locking plates. Methods We performed a retrospective analysis involving 450 patients who underwent distal radius fracture fixations. We evaluated wrist motion, grip strength, and radiographic parameters, including radial inclination, radial tilt, ulnar variance, articular step, and fracture union at standardized intervals. In addition, at the 12- and 24-month marks, we assessed the disabilities of the arm, shoulder, and hand (DASH) questionnaire score. Results Out of the 450 patients who underwent distal radius fracture fixation using volar locking plate systems, 59 individuals (13%) required either autologous bone graft (n = 24) or synthetic bone substitutes (n = 35). In the final follow-up, all fractures had successfully united, displaying an average volar tilt of 4°, radial inclination of 18.8°, and an articular step or gap of 0.1 mm. Conclusion There was no significant difference between the use of autologous or synthetic bone grafts on clinical or radiological outcomes in the long term. Bone grafts are useful in severe metaphyseal comminutionand aid in the reduction of articular fragments and bi-cortical comminution.

SOME CLINICAL CHARACTERISTICS OF ADULT PATIENTS TREATED BY OSTEOSYNTHESIS METHOD FOR THE PROXIMAL HUMERUS FRACTURE

Objectives: To describe some clinical characteristics of adult patients with closed proximal humerus fracture (PHF), treated by osteosynthesis method with locking plate. Subjects and methods: Adult patients who were closed PHF treated by open reduction and locking plate fixation at Military hospital 175. Report of a retrospective study conducted on 42 clinical cases. Results: The average age for both gender was 51.38 ± 14.63, the age group over 60 accounted for 26.19%. The ratio of female/male patients was 1.1/1, the difference was not statistically significant (p&gt;0.05). The cause of injury due to traffic accidents (TA) accounted for the highest rate at 73.81%, due to daily life accidents (DLA) accounted for 21.43%, and due to work accidents (WA) accounted for 4.76%. Anatomical damage of PHF according to the classification of author Neer C.S. on X-ray, including groups III, IV, V, VI, 3-part fractures accounted for the highest proportion with 54.76%. Conclusion: The patients in the study group were mostly middle-aged from 18 to 60 years old. The main cause of TA was the age group from 18 to 60, which was the group with a large traffic demand (accounting for 80.64%), the majority of injuries had 3-4 broken parts (accounting for 61.29%), due to DLA, mainly in the group of people over 60 years old (accounting for 55.56%) with 3-4 broken parts accounting for 66.67%.

First Metatarsophalangeal Joint Arthrodesis With Complete Resection of the Subchondral Bone Plate

First metatarsophalangeal arthrodesis is associated with high union rates but there is a wide range of union incidence reported. Whether the subchondral plate is completely resected, is not reported by individual studies and without meticulous care, there is often residual subchondral plate. The primary aim was to report our union rate following first metatarsophalangeal arthrodesis with complete resection of the subchondral plate, locking plate fixation and immediate protected weight bearing. A retrospective case study of 2 surgeons was performed from August 2016 to June 2023. Our study was unique in that all patients had complete resection of the subchondral plate to trabecular bone. One hundred seventeen feet were identified for analysis, in 112 patients following exclusion criteria. Patients were excluded if they had less than 3 months follow-up, revisional surgery or charcot. Demographic data and indications for the procedure were reported. A single construct locking plate with an interfragmentary compression screw through the plate was used in 37 feet and a locking plate with separate interfragmentary compression screw was used in 80 feet. We reported a nonunion incidence of 0.9% (n = 1) with a delayed union incidence of 0.9% (n = 1) and a broken hardware incidence of 0.9% (n = 1). Complete resection of subchondral plate with early weight bearing and locking plate fixation had a high union rate for first metatarsophalangeal arthrodesis. Our results compare favorably with union rates in the literature, where there is often residual subchondral plate.

Tension band versus locking plate fixation for patella fractures - a protocol of a randomised controlled trial.

Following surgical management of patella fractures, patients commonly report pain; difficulties with weight-bearing tasks such as walking, running and climbing stairs; and restrictions in quality of life. Recently, a locking plate system for surgical management of patella fractures has been introduced. To date, no studies have compared standard treatment with tension band wiring with locking plate fixation in a randomised study design. We aim to compare the one-year patient-reported Knee Injury and Osteoarthritis Outcome subscale scores (KOOS5-subscales) after standard care tension band fixation with locking plate fixation for patients with patella fractures. This is a multicentre randomised and prospective clinical trial. A total of 122 patients will be included in the study, and the primary outcome will be the KOOS subscales at 12 months after surgery. Findings from the present study are expected to advance our understanding of outcome following surgical treatment of patella fractures. This study is funded, in part, by the Novo Nordisk Foundation, Denmark. gov ID: NCT04891549.

A comparative study of volar locking-plate fixation with corticocancellous and pure cancellous bone grafts for scaphoid nonunion with dorsal intercalated segmental instability secondary to scaphoid humpback deformity

IntroductionBone grafts for scaphoid nonunion with deformity include cortcicocancellous or pure cancellous bone grafts. This study compared the outcomes between two types of bone grafts when employing a volar locking-plate in patients with scaphoid nonunion with dorsal intercalated segmental instability (DISI). Patients and MethodsThis retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes. ResultsNineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion–extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences. ConclusionsVolar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports.

Locking plate fixation in comminuted coronoid fractures with partial loss of the articular cartilage – Of basal-1 type according to the O'Driscoll classification –

BackgroundWe have attempted to restore the arc of motion by considering trochlear-coronoid articulation as a complete circle during fixation of the coronoid, even for comminuted coronoid fractures with partial loss of articular cartilage (CCFPLAC), using various kinds of locking plates. Herein, we report the radiological and clinical outcomes after fixation of the basal-1 type of CCFPLAC (O'Driscoll classification) using our method. MethodsThirty-one patients diagnosed with CCFPLAC were admitted between January 2012 and December 2020. Sixteen of these patients met the inclusion/exclusion criteria and were enrolled in this study. Surgically, the lost area (defect of articular cartilage) was never compressed or minimized, but the original height and shape of the coronoid were preserved as is. Provisionally, a few K-wires were used to maintain the original shape and position of the CCFPLAC, and various kinds of locking plates/screws were used to fix the fragment anatomically and firmly. If needed, the plate was bent to ensure stable compression of the coronoid according to its size. In a few cases, locking plates were adjusted by cutting extra screw holes. ResultsAmong the 16 patients, the mean age was 46.2 years, and the male:female ratio was 10:6. The mean follow-up period was 3.63 years. 8, 6, and 2 patients were designated as group 1 (isolated CCFPLAC), 2 [CCFPLAC in type 4 (terrible triad) injury), and 3 (CCFPLAC in type 5 posterior olecranon fracture-dislocations), respectively. Complete union was achieved after a mean of 8.94 weeks. The mean flexion-extension and pronation-supination arcs were 127.19 ± 4.46° and 135.31.59 ± 8.06°, respectively, which were significantly different from those on the contralateral (normal) side (p < 0.001); however, the arcs were within the functional ranges for ordinary daily living. Additionally, the functional status was satisfactory in all patients. However, Mayo Elbow Performance Score and the degree of arthritis were statistically poor in group 2. ConclusionsCCFPLAC of the basal-1 type (O'Driscoll classification) can be treated satisfactorily if already designed and widely distributed locking plates are properly manipulated to maintain the original geometry of the coronoid according to the individual joint characteristics. Level of evidenceLevel IV, Retrospective case series

OPEN REDUCTION AND INTERNAL FIXATION WITH PLATING VERSUS EXTERNAL FIXATOR IN DISTAL END RADIUS FRACTURES: A COMPARATIVE STUDY

Objectives: The purpose of this study is to compare the external fixation and locking plate fixation of intraarticular fractures of the distal radius in terms of functional outcome and complications. The study aims to assess the patients for fracture union, wrist range of motion (ROM), grip strength, pain, and activity among the locking plate and external fixator group. Methods: This study aimed to compare distal end radius external fixator to distal end radius plating regarding functional outcomes. This is an observational type of study where 40 patients were included in the study, among them, 20 were treated with external fixator/k wire and 20 with distal radius plate. The study was conducted in a tertiary care institute during the study period. Results: The most patients were males &gt;50 years of age, with injury caused by a fall on an outstretched hand. In the present study, we got excellent functional results according to the G and O’Brien system in 11 (55%) of patients treated with the plating group, good results in 5 (25%), fair results in 4 (20%), and poor (0%) in the plating. Conclusion: Plating provides better functional outcomes, as assessed by Green and O’Brien’s score, as compared to external fixation. It allows for an early post-operative ROM exercises compared to an external fixator and better anatomical positioning of the fracture segments.

Ulnar carpal translation following palmar locking plate fixation for distal radius fractures: a retrospective analysis

BackgroundConcomitant injuries to the radiocarpal ligaments may occur during episodes of distal radius fractures, which may not cause acute subluxation or dislocation but can lead to radiocarpal instability and progress over time. This study aimed to analyze the occurrence of ulnar carpal translation (UCT) after open reduction and internal fixation of distal radius fractures and evaluate the associated factors of UCT.MethodsThe retrospective study has been done now and includes patients treated between 2010 and 2020 who had undergone reduction and locking plate fixation of distal radius fractures. We assessed radiographs taken immediately after the operation and at 3 months post-operation, enrolling patients with UCT for evaluation. In addition to demographic data, we evaluated radiographic parameters, including fracture pattern, fragment involvement, and ulnar variance. We also assessed the palmar tilt-lunate (PTL) angle to determine associated rotatory palmar subluxation of the lunate (RPSL).ResultsAmong the 1,086 wrists, 53 (4.9%) had UCT within 3 months post-operation. The majority of wrists with UCT exhibited normal to minus ulnar variance (49 wrists; mean: −1.1 mm), and 24 patients (45.3%) had concomitant RPSL. Fracture classification was as follows: 19 type A3 (35.8%), 5 type C1 (9.4%), 11 type C2 (20.8%), and 18 type C3 (34.0%). Radial styloid was involved in 20 wrists (37.7%), palmar rim in 18 wrists (34.0%), dorsal rim in 25 wrists (47.2%), and die-punch fractures in 3 wrists (5.7%). Concomitant ulnar styloid fractures were present in 29 wrists (54.7%).ConclusionThis study highlights the potential for UCT to occur following reduction and fixation of distal radius fractures, particularly in cases with a more severe fracture pattern and combined with ulnar minus variance. The high incidence of concomitant RPSL provides further evidence for the possibility of associated radiocarpal ligament insufficiency after distal radius fracture.

Primary stability in locking plate fixation for proximal humeral fractures may be increased by using an additional nail osteosynthesis in combination with locking plate osteosynthesis—A biomechanical comparison

BackgroundStability is regarded as an important factor for proper healing and avoiding secondary dislocation in osteoporotic fractures of the proximal humerus. Several surgical techniques have been proposed for treatment, including intramedullary nail osteosynthesis and locking plate fixation. This study introduces a novel approach that combines both techniques and compares its primary stability with conventional methods. MethodsThe study involved 25 osteoporotic humeri with two-part fracture models, which were randomly assigned to locking-plate fixation, intramedullary nailing, or a combination of both techniques. The specimens were subjected to sinusoidal loading at 250 N in 20° abduction for 5000 cycles and then to quasi-static loading until failure. Fracture movement, failure mode, and failure load were measured and compared among the groups. FindingsThe groups fixated with intramedullary nailing and the groups fixated with intramedullary nailing and locking plate fixation showed significantly lower fracture motion than the group using locking plate fixation only (p < 0.005) and significantly higher load to failure (p = 0.007 and p = 0.0062, respectively). There was no significant difference between the group using intramedullary nailing and the group using locking-plate fixation and intramedullary nailing in fracture movement or load-to-failure (p > 0.005). InterpretationThe results indicate that locking plate fixation provides less primary stability than intramedullary nailing or the combined of both techniques. This combined approach may offer advantages as a treatment for complex proximal humeral fractures in osteoporotic bone, and specific implants should be developed to ensure optimal treatment.

Flexor Pollicis Longus Reconstruction After Rupture Following Distal Radius Fixation With Volar Locking Plate: A Technique Guide.

Flexor pollicis longus rupture is an uncommon but potentially debilitating complication after volar locking plate fixation of distal radius fractures, occurring secondary to tendon attrition against the implant. This nature of tendon injury typically precludes primary repair. This paper will illustrate 2 reconstruction techniques, an interpositional tendon graft and a tendon transfer, that have been utilized successfully by the authors.

Interfragmentary compression force and fixation stability of lateral tibial plateau fractures in normal and osteoporotic bones.

Lateral platform collapse in fixations of lateral tibial plateau fractures (TPFs) using either double-lag screws fixation (DSF) or locking-plate fixation (LPF) is not rare. This study aimed to explore the effect of enhancing the interfragmentary compression force (IFCF) on fixation stability in lateral TPFs in normal and osteoporotic bones using finite element analysis. Finite element models of DSF in normal bone and LPF in normal and osteoporotic bones were established to simulate the fixations of lateral TPF. After model validation, axial compressive forces of 500, 1000, 1500, and 2500 N to the tibial plateau along with an IFCF of 0, 100, 200, and 300 N were applied. The maximum axial micromotion of the lateral fragment (MAM-LF), maximal translational micromotion of the lateral fragment (MTM-LF), peak von Mises stress (VMS), and peak equivalent elastic strain of the lateral fragment (EES-LF) were evaluated. The MAM-LF showed a decreasing trend as the IFCF increased in all models. For DSF models, the peak VMS of implants increased as the IFCF increased when the axial loads were 500 and 1000 N. The peak EES-LF decreased as the IFCF increased under axial loads of 1000, 1500, and 2500 N. For the normal and osteoporotic LPF models, the peak VMS of the implants decreased as the IFCF increased. Peak EES-LF decreased as IFCF increased. In conclusion, enhancing IFCF was beneficial in improving the fixation stability of lateral TPF. The optimal IFCF for DSF and LPF should be as high as reasonably feasible.

Adjunctive dorsal spanning plate fixation for challenging distal radius injuries

BackgroundDistal radius fractures with severely osteoporotic bone or articular comminution can provide challenges to fixation with traditional volar locked plating alone. The purpose of this study was to evaluate the clinical, radiographic, and patient reported outcomes of patients undergoing distal radius fixation with volar locked plating and adjunctive dorsal bridge plating. MethodsWe retrospectively identified 16 patients with distal radius fractures who underwent our preferred surgical technique for fixation. Patients underwent volar locked plate fixation as well as dorsal bridge fixation at time of surgery. Seven patients were indicated for severe articular comminution with volar rim fragmentation (44%), three patients were revised for nonunion after previous volar locked late fixation (19%), and six patients had severely osteoporotic bone with articular comminution (38%). Two patients (13%) sustained AO/OTA 23-A3 distal radius fracture, two patients (13%) had a 23-B3 fracture, two patients (13%) had a 23-C2 fracture and ten patients (63%) had a 23-C3 fracture. ResultsThe average patient age was 51.8 years ± 20.6. Patients were followed for an average of 12.2±6.3 months. The dorsal bridge plate was removed at an average of 11.1±2.4 weeks. The average post-operative radial inclination was 18.9±2.4°, radial height 12.4 mm ± 2.6 mm, and volar tilt 7.1±1.9°. There were no cases of deep or superficial infection. After dorsal bridge plate removal, patients demonstrated an average wrist extension of 55.3±9.5°, flexion 54.4±12.8°, radial deviation 15.7±3.2°, 25.2±3.9 degrees of ulnar deviation. ConclusionDistal radius fractures in the setting of severely osteoporotic bone, salvage procedures, articular comminution, volar rim fractures, and revision surgery present uniquely difficult surgical challenges. Volar locked plating with adjunctive dorsal bridge plating can be used with good short- and long-term results.

Application of Intramedullary Calcar Support Plate and Lateral Locking Plate in Elderly Patients with Neer 3 and 4-Part Fractures of Proximal Humerus Through a Deltoid Splitting Approach

BackgroundThe reduction and fixation of Medial humeral calcar is difficult in the treatment of elderly proximal humerus Neer 3 and 4-part fractures with a single lateral locking plate. Our study investigated the efficacy of an intramedullary calcar supporting plate combined with a lateral locking plate for the treatment of 3- and 4-part fractures of the proximal humerus in the elderly through a deltoid splitting approach.MethodsFrom June 2022 to December 2022, we treated six elderly patients with Neer 3 and 4-part fractures using proximal humeral intramedullary calcar support plate in combination with lateral locking plate through a deltoid splitting approach. Follow-up time was 6–12 months. Assessment indicators included fracture union, quality of reduction, and complication rate. The Constant-Murley score was used to record shoulder function at 6 months postoperatively.ResultsAll 6 patients showed fracture union and anatomic reduction. Constant-Murley score was 79.5 (70–90) at 6 months postoperatively. There was no incision non-healing, internal fixation failure, bone non-union or surgical site infection, secondary surgery, or death. Shoulder impingement occurred in 1 case.ConclusionProximal humeral intramedullary calcar support plate combined with lateral locking plate fixation through a deltoid splitting approach can effectively maintain fracture reduction, prevent inversion collapse of humeral head and internal fixation failure, and provide satisfactory clinical results at an early stage.

Comparison of Locking Plate Alone and Locking Plate Combined with 3D Printed Polymethylmethacrylate Augmentation in Treating Proximal Humerus Fractures in the Elderly

BackgroundLocking plates are widely used in open reduction internal fixation (ORIF) for proximal humeral fracture (PHF). However, the optimal surgical treatment of unstable, displaced PHF in elderly patients remains controversial. This study aimed to compare the radiological and clinical outcomes of surgical treatment of PHF in the elderly with locking plate (LP) alone and locking plate combined with 3D printed polymethylmethacrylate (PMMA) prosthesis augmentation (LP-PA). MethodsFrom May 2015 to April 2021, a total of 97 patients aged ≥ 60 years with acute unstable PHF who underwent osteosynthesis with either LP (46 patients) or LP-PA (51 patients) were retrospectively analyzed. For the LP-PA group, a customized proximal humeral prosthesis made of PMMA cement was intra-operatively fabricated by a three-dimensional (3D) printed prototype mold for the humeral medial support. Radiological outcomes were analyzed by measuring the value of neck-shaft angle (NSA) and humeral head height (HHH). The clinical outcomes were evaluated using Constant-Murley Score (CMS), Disabilities of the Arm Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and the shoulder range of motion (ROM). Pain was measured using a visual analogue scale (VAS). ResultsAt the one-year follow-up, all fractures healed radiologically and clinically. The mean changes of NSA and HHH over the follow-up period were markedly smaller in the LP-PA group (3.8 ± 0.9° and 1.7 ± 0.3 mm) than those in the LP group (9.7 ± 2.1° and 3.2 ± 0.6 mm, both P < 0.0001). The LP-PA group also presented lower DASH score (17.1 ± 3.6), higher ASES score (89.5 ± 11.2) and better ROM in forward elevation (142 ± 26°) and external rotation (59 ± 11°) compared to the LP group (28.9 ± 4.8 for DASH score, P < 0.0001; 82.3 ± 9.0 for ASES score, P < 0.001; 129 ± 21° for forward elevation, P = 0.008; and 52 ± 9° for external rotation, P = 0.001). There was no significant difference in overall complication rate between the two groups, although the complication rate of screw perforation was higher in the LP-PA group (P = 0.172). ConclusionsFor PHF in elderly patients, the combination of LP fixation and PMMA prosthesis augmentation effectively improved humeral head support and reduction maintenance, providing satisfactory outcomes both radiologically and clinically. This technique also reduced the incidence of screw perforation associated with plate fixation alone, making it a reasonable option to ensure satisfactory clinical outcomes.

Comparing Intramedullary Nails and Locking Plates in Displaced Proximal Humerus Fracture Management: A Systematic Review and Meta-Analysis.

This study aims to provide an updated review comparing the complication rates and clinical outcomes of intramedullary nails and locking plates (LPs) in displaced proximal humerus fracture (PHF) management. We performed a systematic review of the Cochrane Central Register of Controlled Trials, Clinical Trials Registry, EMBASE, and PubMed. Studies with level III evidence or higher comparing intramedullary nails and LPs used for internal fixation of displaced PHFs were included. The Methodological Index for Nonrandomized Studies (MINORS) criteria and Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 were used to assess the risk of bias. Our meta-analysis included a comparison of method-related complications, pain scores, range of motion (ROM), and functional scores. A total of 13 comparative studies were included: five randomized controlled trials, three prospective cohort studies, and five retrospective cohort studies. The total number of patients included was 1,253 (677 in the LP group and 576 in the intramedullary nail group). Superior Constant-Murley scores and external rotation ROM were found in the LP group during the early postoperative period. However, long-term functional scores and complication rates were comparable between the two groups. We conclude that intramedullary nailing and LP fixation are both equally effective for the treatment of displaced PHFs. Neither treatment appears superior at this time, and more large-scale randomized controlled trials should be conducted to further evaluate the potential benefit of LPs in the early postoperative period.