Outcomes Of Proximal Humeral Fractures Research Articles

Influence of Proximal Humeral Cortical Bone Thickness on the Radiographic Outcome After Osteosynthesis of Proximal Humeral Fractures: Propensity Matching Score Analysis.

Osteoporosis can affect the surgical outcomes of proximal humeral fractures in older people. Recently, the cortical bone thickness of the proximal humerus on plain radiograph has been proposed to reflect local osteoporosis of the proximal humerus; however, its effect on the surgical outcome of proximal humeral fractures remains unclear. The purpose of this study is to investigate the influence of cortical bone thickness on postoperative radiographic outcomes after osteosynthesis for proximal humeral fractures. We retrospectively identified 190 patients (≥50years) who underwent osteosynthesis with an intramedullary nail or plate for proximal humeral fractures. The patients were categorized into 2 groups according to the cut-off value of an average proximal humerus cortical bone thickness of 6mm on plain radiographs: patients with and without local osteoporosis. After propensity score matching, we compared the incidence of postoperative radiographic complications between the 2 groups. We also performed subgroup analyses of outcomes in a subgroup of patients who underwent intramedullary nailing and those who underwent plate fixation. Propensity score matching yielded 60 patients in each group. No significant difference in complication rates was observed between the 2 groups. However, in the intramedullary nailing subgroup, the incidence of reduction loss was significantly higher in patients with local osteoporosis than in those without local osteoporosis (51.7% vs 14.3%, P = .002). The proximal humeral cortical bone thickness had no significant effect on the overall radiographic outcome; however, reduction loss after intramedullary nailing was susceptible to local osteoporosis of the proximal humerus. Our study suggests that plate fixation is advantageous in preventing postoperative reduction loss in patients with lower cortical bone thickness.

Effect of the Initial Deformity in the Coronal Plane on Postoperative Outcome of Proximal Humeral Fractures.

There is currently no consensus on proximal humerus fractures with an initial deformity in the coronal plane who are better off with plates or nails, so we designed this study. To compare the effect of the initial deformity in the coronal plane of proximal humerus fractures on postoperative outcomes, we compare the maintenance of reduction in procedures utilizing plates and nails, and analyzed the subsequent occurrence of complications to explore whether the initial deformity should dictate the fixation approach. The clinical data of patients with proximal humerus fractures who were hospitalized and underwent surgical treatment in our hospital from January 2016 to December 2020 were reviewed. Postoperative functional scores (American Shoulder and Elbow Surgeons, ASES; Constant-Murley Score, CMS), Neck-shaft angle (NSA), Quality of fracture reduction, Deltoid Tuberosity Index (DTI), and complications were compared among cases with initial varus, normal, or valgus deformities. We included 131 patients, 56 males and 75 females, with a mean age of 60.89 ± 5.53 years (range 50-76) and a mean follow-up duration of 16.63 ± 6.78months (range 12-48). Of these, 29 cases had initial varus displacement, 71 had a normal NSA, and 31 had initial valgus displacement. Seventy-five were treated with a locking plate and 56 with a nail. After open reduction and internal fixation, the NSA was restored to normal (-135°) in all patients in all groups (P > 0.05). There was a significant difference in NSA changes at the last follow-up; 2.93° ± 2.12° in the varus group, 1.77° ± 1.18° in the normal group, and 2.32° ± 1.64° in the valgus group, with the highest change occurring in the varus group. There was no significant difference in the range of motion or functional scores including ASES and CMS among the three groups (P > 0.05). The complication rate of 20.7% in the varus group was significantly higher than the complication rates of 12.7% in the normal and 12.9% in the valgus groups (P < 0.05). While proximal humerus fractures with initial coronal displacement (varus, normal, and valgus) show similar postoperative functional outcomes, varus fractures have a higher rate of complications. The nail provides better maintenance of reduction than the locking plate, especially in varus fractures.

Assessment of Functional Outcome of Surgical Management of Proximal Humerus Fracture Treated with PHILOS Plate

Background: This study is conducted to evaluate the results in terms of functional outcome of proximal humeral fractures treated by anatomic locking compression (PHILOS- proximal humerus interlocking system) plate.&#x0D; Methods: This prospective study was a study on patients with fracture of proximal humerus. Patients who fulfilled the inclusion criteria were invited to participate in the study. Informed consent was obtained from all the patients willing to participate in the study.&#x0D; Results: The average constant and murley score after 6 weeks was 33.34 point, after 3 month it was 54.02 points and after 6 month it was 73.6 point . For the same time zones the mean score for type A was 37.47 , 58.35, 77.12, for type B was 34.64, 55.95, 75.69 and for type C was 33.44, 54.14, 73.71 at 1.5, 3 and 6 month respectively.&#x0D; Conclusions: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.&#x0D; Keywords: Philos plating, Proximal humerus fractures, Shoulder fractures

Proximal humeral fractures treated with a low-profile plate with enhanced fixation properties

BackgroundOur purpose was to evaluate the clinical and radiographic outcomes of proximal humeral fractures treated with a new generation plating system and compare results with a meta-analysis of recent literature. MethodsBetween 2014 and 2017, 93 patients (18 males, 75 females) with proximal humerus fractures were treated with open reduction and internal fixation (ORIF) using a Pantera® Plate. These low-profile plates are anatomically shaped and include “cross-elements” that form a three-dimensional scaffold in bone to enhance fixation stability. According to Neer classification, there were 24 two-part fractures, 49 three-part fractures and 20 four-part fractures (4 with dislocated heads). X-rays and Constant Shoulder Scores (CSS) were used to evaluate healing, complications, and clinical outcomes. Results were compared with a meta-analysis of similar studies reported in literature over the last 10 years. ResultsEighty-three patients with a minimum follow-up of 2 years had a mean CSS of 72 (53–90) graded as excellent for 23 patients (28%), good for 35 (42%), fair for 14 (17%), and poor for 11 (13%). Fractures healed without complication in 75 (91%) patients. Eight (9%) complications were observed, i.e., three avascular necrosis of the humeral head, one case of implant loosening, two cases of subacromial impingement and two superficial infections. There was no significant correlation between Neer fracture stage and patient outcome (p = 0.257). Compared to the literature, this method had a lower complication grade (p = 0.03), though it did not significantly differ in its clinical outcomes (p = 0.08). ConclusionsThe investigated plating system includes design features that can potentially increase utility for ORIF of proximal humeral fractures. While the complication profile was signficantly less than reported in the literature for standard proximal humerus plates, clinical outcomes were similar. Further studies will be required to better understand the role of plate design on treatment of these challenging fractures. Level of evidenceIV, therapeutic study.

Effect of Deltoid Tuberosity Index on the Outcome of Proximal Humeral Fracture Treated with a Locking Plate

Background: In the elderly, proximal humerus fractures are not unusual. The treatment of these injuries are often complicated.Objectives: This study aimed to evaluate the effect of deltoid tuberosity index on the outcome of proximal humeral fractures treated with a locking plate.Methods: One hundred consecutive patients with displaced fractures of the proximal humerus had open-reduction and internal fixation using a locking plate. The patients were divided into two main groups (low density group) DTI 1.4 (normal density group) and at the end of the study, treatment and failure were assessed in the two groups.Results: In this study, 100 patients with proximal humeral fracture who were candidates for locking plating surgery were evaluated. The mean of DTI in all patients was 1.48 with a minimum of 1.10 and a maximum of 2.20. Based on the Pearson correlation coefficient, with increasing age, the constant score decreased in the studied patients, which was statistically significant (r=-0.216, p-value = 0.031). Also, in patients with DTI less than 1.4 and more than 1.4, the Constant score was 73.02 and 77.88, respectively. This difference was not statistically significant (p-value=0.054). There was a statistically significant relationship between Constant Score, DTI and patients' gender (p-value≤0.05). While there was no statistically significant relationship between fracture type and constant score. Pearson correlation coefficient between DTI and age of patients was -0.30, which decreased with increasing age of patients. This was statistically significant (r=-0.30, p-value=0.003).Conclusion: The results of this study show that the deltoid tuberosity index can be effective on proximal humoral fracture surgery treated with locking plating.

Nonsensus in the treatment of proximal humerus fractures: uncontrolled, blinded, comparative behavioural analysis between Homo chirurgicus accidentus and Macaca sylvanus

ObjectiveTo investigate the inter-rater reliability of Barbary macaques compared with an expert group of surgeons for the choice of treatment and predicted outcome of proximal humerus fractures.DesignUncontrolled, blinded, comparative behavioural...

Preliminary clinical and radiographic outcomes of proximal humeral fractures: comparison of ALPS and PHILOS plating in Asian patients in Taiwan

BackgroundUp to 20% of proximal humeral fractures need to be treated operatively. However, numerus complications were reported by using fixed angled locking plates. The ALPS Proximal Humerus Plating System is a new design implant with novel design features.The aim of this study was to compare the preliminary clinical outcomes and complications of proximal humeral fractures treated with either ALPS or the proximal humeral internal locking system (PHILOS) in Asian patients in Taiwan.MethodsBetween January 2016 and December 2018, 66 patients with displaced proximal humeral fractures were analyzed retrospectively, of whom 31 underwent ALPS implant treatment and 35 underwent PHILOS implant treatment. Intraoperative blood loss and operation time, postoperative Constant-Murley Shoulder Outcome (Constant-Murley) score, and complications variables were recorded for the comparison. All cases were regularly followed up for at least 1 year.ResultsThe mean follow-up period was 400.8 days (range, 367–446 days). Union was achieved in 98.5% of patients (65/66). The ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for treating displaced proximal humeral fractures, including operation time, intraoperative blood loss, the Constant-Murley score, and varus malunion (P > 0.05, respectively). However, the incidence of total postoperative complications in the ALPS group was significantly lower than in the PHILOS group (P < 0.05). There was a trend of a lower complication rate of screws/pegs protrusion, avascular necrosis, subacromial impingement, postoperative infection, and reoperation in the ALPS group, although it was not statistically significant (P > 0.05, respectively).ConclusionThe ALPS group yielded similar radiologic and clinical outcomes to the PHILOS plating group for displaced proximal humeral fractures, but the ALPS group had a significantly lower total rate of complications. Therefore, ALPS may be a better option for treating proximal humeral fractures. Further larger clinical studies are needed to confirm the findings presented here.Trial registrationRetrospective study

Functional Outcome of Proximal Humerus Fractures Treated with Closed Reduction and Percutaneous Pinning

Background: Fractures of proximal humerus are very common. Many options are available for its management including non-operative management. Reconstruction of the articular surfaces including restoration of the anatomy and a stable fixation with minimal soft tissue damage is the main principle of this procedure. Percutaneous pinning is the less invasive, less time consuming and reliable procedure and avoids complications such as avascular necrosis, infections and heavy weight bearing implants. Aims and Objectives: 1. To study the clinical profile of adult patients with proximal humeral fractures. 2. To study the functional outcome of closed reduction and percutaneous pinning of proximal humeral fractures. 3. To study the factors affecting functional outcome of proximal humeral fractures. Materials and Methods: This is a prospective study among 32 patients on whom percutaneous pinning was done after closed reduction for the fractures of proximal humerus. This study was conducted from August 2014 to December 2016. Results: According to Neer's functional assessment score the functional outcome was excellent in 18 (56.3%) patients, satisfactory in 6 (18.8%) patients, unsatisfactory in 7 (21.9%) patients and failure in 1 (3.1%) patient. Conclusion: Percutaneous pinning is simple, less invasive, reliable and effective procedure. It reduces risk of heavy implant bearing, infection and avascular necrosis.

Clinical outcome of proximal humeral fractures treated by locking plate

Clinical outcome of proximal humeral fractures treated by locking plate

Study on functional outcome of proximal humerus internal locking osteosynthesis system plating for displaced proximal humerus fractures: A prospective and retrospective study

Background: Management of proximal humerus fractures still remains controversial. The goal of proximal humerus fracture fixation is to achieve stable anatomical reduction and to allow early mobilization. There are many methods of fixation of proximal humerus fractures. This study focuses on fuctional outcome of proximal humeral fractures fixed with Proximal Humeral Internal Locking Osteosynthesis System (PHILOS) plating.Methods: Fifty-five patients who underwent surgery with PHILOS plate for displaced proximal humerus fractures were analysed. The classification method used was Neer’s classification. All patients had a radiographic and clinical follow-up performed at one, three and six weeks, one and six months and at one and two years. The clinical outcomes were measured with the use of the Constant-Murley system.Results: Out of 55 patients, 10 patients (18%) had excellent functional outcome, 34 patients (62%) had good outcome, 8 patients (15%) had moderate outcome and 3 patients (5%) had poor outcome according to Constant-Murley scoring system. Complications were noted in 10 of 55 patients. The mean Constant-Murley score was 75.27 ± 10.56. The mean time to bone union was about 12 weeks in 90% of patients. Ten patients developed complications (18.18%) which included 1 avascular necrosis (1.82%), 3 impingements (5.45%), 2 implant failures (3.64%), 2 nonunions (3.64%) and 2 stiffness (3.64%). The mean Constant Murley score for Neer’s two-part fracture was 84.83 ± 8.77, for three part it was 79.91 ± 6.24 and for four part fracture the score was 68.52 ± 10.27. Mean Constant Murley for patients aged < 60 years was 80.73 ± 7.15 and the score for more than 60 years age was 68.72 ± 10.35. The correlation between mean Constant Murley score and Neer’s 2, 3 and 4 part fractures (p < 0.001) and age (p < 0.0001) was found to be considered statistically significant.Conclusion: Proximal humeral locking plate is a good method of osteosynthesis for complex proximal humerus fractures allowing early mobilization, good functional outcome. The PHILOS plate is an ideal construct and a stable implant to use for fractures of the proximal humerus in Neer’s 2-part, 3-part, and 4-part and osteoporotic fractures. Proper surgical technique and skills can be incorporated to avoid the complications.

A prospective study on functional and radiological outcome of proximal humeral fractures treated with locking compression plates

Fractures of proximal humerus account for about 4 to 5% of all fractures. It is the third most common fracture after hip fracture and colles fracture in elderly patients. In this study we have analysed 20 cases of proximal humeral fractures treated surgically using (PHILOS) proximal humerus locking compression plates admitted at Department of Orthopaedics and Traumatology, Government Kilpauk Medical College and Hospital, Chennai from April 2013 to November 2013. The aim of the study was to analyze the functional and radiological outcome and to assess the complications of proximal humeral fractures treated using locking compression plates. Patients with proximal humerus fractures, who are skeletally mature and age more than 18 years satisfying Neer s criteria for operative displacement were selected. The patients were operated by the standard anterior deltopectoral approach or deltoid splitting approach using proximal humerus locking plates. All the patients were reviewed at two weeks interval, for first three months and later every month, Radiological evaluation of fracture union was observed by serial X rays. Constant and Murley’s score was used to assess the functional outcome of our patients. The average constant score in our study with 20 patients was 82.4. Finally we concluded that displaced proximal humeral fractures when treated surgically produce greater range of movements (ROM), less pain and less stiffness.

Does grafting of the tuberosities improve the functional outcomes of proximal humeral fractures treated with reverse shoulder arthroplasty?

Functional outcomes of reverse total shoulder arthroplasty (rTSA) can be improved by fixation of the tuberosities. This study compares clinical and radiologic results of patients with comminuted proximal humeral fractures treated with rTSA, with and without autologous grafting. Thirty-three patients with proximal humeral fractures were treated with rTSA and tuberosity fixation. In 18 patients (group I; mean age, 75 years), tuberosity fixation was augmented with autografting; in 15 patients (group II; mean age, 71 years), graft augmentation was not used. The mean follow-up was 16.7 (range, 12-24) months in group I and 16.8 (range, 12-25) months in group II. Radiologic tuberosity union was achieved in 14 of 18 (77.8%) patients who underwent autograft augmentation and in 6 of 15 (40.0%) patients treated without autografting. The mean American Shoulder and Elbow Surgeons (ASES) score was 69.6 ± 13.0 in group I and 51.0 ± 20.0 in group II. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 31.9 ± 24.0 in group I and 58.2 ± 24.6 in group II. A significant difference was detected between groups for ASES and DASH scores. Among shoulder range of motion measures, only forward flexion differed significantly between groups I and II (124° ± 23° vs. 98° ± 30°, respectively). External rotation muscle strength was significantly higher in group I (3.36 ± 1.46 kg) than in group II (2.39 ± 2.00 kg). In the treatment of complex proximal humeral fractures in elderly patients by rTSA, cancellous block autograft augmentation can increase the rate of tuberosity union and improve functional outcomes.

Clinical outcomes and prognostic factors depending on implant design in the treatment of proximal humeral fractures: A retrospective study

PurposeWe aimed to examine the clinical outcomes of proximal humeral fractures treated with different intramedullary nail shapes. MethodsThirty-seven patients were divided into two groups depending on the implant shape. We also defined F group as a subgroup of fracture classification. ResultsIn the F group, the flexion of the shoulder joint was significantly greater in S (mean, 134.6°) than in C groups (mean, 109°) (p=0.04). The complication rate was significantly larger in the C group (p=0.04). ConclusionsPatients with one kind of fracture and who were treated with straight nails had better outcomes.

Early Results of Three and Four Part Proximal Humerus Fractures Treated with PHILOS (Proximal Humerus Interlocking System) Plate

Achieving stable fixation has been a challenge in proximal humerus fractures. PHILOS (Proximal Humerus internal locking system) is the latest generation of locking compression plate system for such fractures. The aim of the current study was to assess the clinical and functional outcome of proximal humeral fractures (3-part and 4-part) treated with the PHILOS plate. This was a retrospective review of first ten cases operated at our centre by a single surgeon. The patients were followed in out-patient clinics till fracture union. Fracture healing was assessed by clinical and radiological criteria, and shoulder function was evaluated using Constant and Murley score. Average follow-up was 23±3 weeks. Eight (80%) patients had fracture healing at an average of 11.6±0.8 weeks post-operatively, and gained moderate range of motion. Two (20%) patients had complications, i.e. one had deep infection and another had screw pull-out. Conclusion: Open reduction and internal fixation with PHILOS plate showed acceptable functional outcome. Apart from the one case with screw-pull-out, our early results using this plate are encouraging, with no other implant-related complications and good early healing.

Isokinetic strength test and functional outcomes in proximal humeral fractures treated with a locking plate

Background Despite the use of many shoulder outcome scales in subjects with rotator cuff pathology or instability symptoms, it can be problematic to select an instrumental evaluation in the shoulder trauma population. In this study we evaluated patients with proximal humeral fractures treated with internal fixation with a locking plate, analyzing the recovery of strength with an isokinetic test and its correlation with clinical and functional outcomes.Methods We enrolled 46 individuals (17 men, 29 women). The evaluation included a structured interview, measurement of ROM, isokinetic strength test and Constant-Murley and QuickDASH scores. The isokinetic test was performed in flexion/extension and external/internal rotation of the operated shoulder in comparison with the contralateral side and concentric contractions in all movements. The parameter tested was peak torque.Results In the operated shoulder values we noticed a statistically significant correlation between the QuickDASH and Constant-Murley score. QuickDASH showed a significant correlation with flexion isokinetic strength, partial correlation with extension isokinetic values and no correlation with external/internal rotation values. In addition, we found a correlation between the Constant-Murley score and all the isokinetic strength parameters. Comparing the operated shoulder and the contralateral, in Neer type 2 fractures there was no significant difference in all the isokinetic peak torque values; in Neer type 3 and type 4, there was a significant statistical difference in both flexion peak torque values and no significant difference in the other movements.Conclusions The isokinetic test can give objective data on strength recovery and could help the surgeonʼs clinical evaluation to assess the functional recovery of the operated shoulder over time. We believe that the isokinetic test and Constant-Murley score could act as a reference in the evaluation of post-surgical outcome of proximal humeral fractures. Furthermore, the type of fracture could be a post-surgical limb recovery predictor and the shoulder flexion force could be the best functionality recovery indicator.

The outcome of proximal humeral fractures in the elderly: predictors of mortality and function.

This study describes the epidemiology and outcome of 637 proximal humeral fractures in 629 elderly (≥ 65 years old) patients. Most were either minimally displaced (n = 278, 44%) or two-part fractures (n = 250, 39%) that predominantly occurred in women (n = 525, 82%) after a simple fall (n = 604, 95%), who lived independently in their own home (n = 560, 88%), and one in ten sustained a concomitant fracture (n = 76, 11.9%). The rate of mortality at one year was 10%, with the only independent predictor of survival being whether the patient lived in their own home (p = 0.025). Many factors associated with the patient's social independence significantly influenced the age and gender adjusted Constant score one year after the fracture. More than a quarter of the patients had a poor functional outcome, with those patients not living in their own home (p = 0.04), participating in recreational activities (p = 0.01), able to perform their own shopping (p < 0.001), or able to dress themselves (p = 0.02) being at a significantly increased risk of a poor outcome, which was independent of the severity of the fracture (p = 0.001). A poor functional outcome after a proximal humeral fracture is not independently influenced by age in the elderly, and factors associated with social independence are more predictive of outcome.

The Analysis of the Treatment Outcomes of Proximal Humeral Fractures with Locking Plates

BACKGROUND: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes.METHODS: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications.RESULTS: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient).CONCLUSIONS: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

Social deprivation influences the epidemiology and outcome of proximal humeral fractures in adults for a defined urban population of Scotland

We present the epidemiology and incidence of proximal humeral fractures over a 17-year period for a defined urban population that represents approximately 13% of the population in Scotland, and functional outcome in relation to the socio-economic status of the patient. The incidence of proximal humeral fractures significantly increased during the study period from 47.9/10(5)/year to 98.7/10(5)/year in 2008 (p < 0.0001), which was greatest for the most socially deprived patients reaching 274.2/10(5)/year in 2008 (p < 0.0001). The most deprived patients sustained their fracture 4 years earlier than the most affluent patients (p = 0.026). Social deprivation was an independent predictor, after adjusting for other confounding variables using multivariable regression analysis, of a significantly worse functional outcome according to the Constant score at 1 year (p = 0.046). Preventative measures, especially for the most socially deprived patients within society, need to be instigated urgently to address the increasing incidence of proximal humeral fractures and alleviate the burden of these morbid fractures in the future. Whether the observed increased incidence is generalisable to a national population would need to be confirmed in future studies.

Plating of Proximal Humeral Fractures

The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.

Operative outcome of proximal humeral fractures with use of the locking proximal humerus plate

Operative outcome of proximal humeral fractures with use of the locking proximal humerus plate