Locking Proximal Humeral Plate Research Articles

Adult Proximal Humeral Locking Plate Is a Good Alternative Option in the Treatment of Adolescent Subtrochanteric Femur Fractures: A Case Series and Literature Review.

Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs). A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d'Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM). The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients' mean hip ROM values were as follows: 17.77±3.52° in extension, 115.27±6.74° in flexion, 43.05±3.48° in abduction, 27.50±4.28° in adduction, 42.22±4.60° in internal rotation, and 42.22±3.91° in external rotation. Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.

Using the Greater Tuberosity as a Reference for Placement of Proximal Humerus Plates Leads to a High Rate of Calcar Screw Malposition.

Achieving calcar fixation is critical to minimize the failure of proximal humerus fractures repaired with proximal humeral locking plates (PHLPs). Many operative technique manuals reference the greater tuberosity (GT) for plate placement. The objective of this study was to examine the accuracy of calcar screw placement when PHLPs were placed based on distance from the GT. Twenty cadaveric specimens were acquired representing a height distribution across the US population. Thirteen different PHLPs were applied. A drill bit was placed through the designated calcar screw hole and measured on radiographs, with the inferior 25% of the head representing an ideal placement. Three hundred fifty constructs were studied. In 28% of the specimens, the calcar screw was misplaced. In 20% of the specimens, it was too low, whereas in 8%, it was too high. The calcar screw missed low in 30% of patients shorter than 5 feet, 5.5 inches versus 8% of taller patients ( P = 0.007). It missed high in 13% of taller patients versus 2% of shorter patients ( P = 0.056). Calcar screws in variable-angle plates missed 0% of the time, whereas those in fixed-angle plates missed 36% of the time ( P = 0.003). Placement of PHLPs based on distance from the GT results in unacceptable position of the calcar screw 28% of the time and up to 36% in fixed-angle plates. This could be further compounded if the GT is malreduced. Current technique guide recommendations result in an unacceptably high rate of calcar screw malposition.

Biomechanical comparison of tuberosity-based proximal humeral locking plate compared to standard proximal humeral locking plate in varus cantilever bending

PurposeIn a prior biomechanical study using a tuberosity-based proximal humeral locking plate (TBP) an improvement in greater tuberosity (GT) fixation strength with the TBP compared to a standard proximal humeral locking plate (PHLP) was demonstrated. The purpose of this study is to compare the TBP to the PHLP with a simulated calcar gap fracture under cyclic varus cantilever forces. MethodsSeven matched pairs of cadaveric humeri were studied and 11A2.3 proximal humerus fractures were created by a 1 cm gap osteotomy at the surgical neck. Matched pairs were randomized for fixation using either a PHLP or a TBP. The proximal articular aspect of the humerus was potted and secured to the base of a load frame. The shaft was subjected to cyclic varus cantilever loading with a roller positioned 8 cm from the osteotomy. Change in vertical displacement of the diaphyseal fragment was monitored and digital images were obtained. Failure was defined as vertical displacement greater than 20 mm. Specimens not exhibiting failure over the course of 10,000 cycles were then loaded to 20 mm of vertical displacement. Reactant forces of the specimens at these displacements were recorded. ResultsFour/seven TBP specimens and four/seven PHLP specimens survived 10,000 cycles. The average cycles to failure for TBP specimens was 7325 cycles and 5715 cycles for PHLP specimens (p = 0.525). For the specimens that survived 10,000 cycles, the decrease in calcar gap was superior in the TBP specimens (p = 0.018). A similar trend was seen when these specimens were loaded to failure where the percent calcar gap recovery was higher for the TBP at 74.71 ± 10.07% versus 53.22 ± 30.35% for the PHLP (p = 0.072). In specimens that were loaded to failure after survival of 10,000 cycles the average stiffness of the TBP construct was 20.51 N/mm, and 11.74 N/mm for the PHLP construct (p = 0.024). ConclusionIn addition to superior GT fixation shown in a prior study, the TBP construct demonstrates significantly greater stiffness at the neck fracture compared to the PHLP, when loaded to failure. In addition, there was a trend towards less collapse in this calcar gap model.

Efficacy of Intramedullary Nailing in the Treatment of Comminuted Proximal Humeral Fractures and Its Influence on Shoulder Joint Function Recovery.

In this paper, we have aimed to elucidate the therapeutic effect of intramedullary nailing (IMN) in treating comminuted proximal humeral fractures (CPHFs) and its influence on the recovery of shoulder joint function. For this purpose, 60 cases with CPHFs were selected, particularly from January 2020 to October 2021. In these cases, 28 cases were treated with a locking proximal humeral plate (LPHP) and assigned to the control (Con) group and the remaining 32 patients were treated with IMN and included in the research (Res) group. The therapeutic effect, surgical indicators, total complications, visual analogue scale (VAS) score, and postoperative shoulder joint function score were compared between the two arms. We observed that compared with the Con group, the effective rate in the Res group was higher while the operation time, intraoperative blood loss, and fracture healing time were shorter, the overall complication rate and VAS score were lower, and the postoperative shoulder joint function score was higher, all with statistical significance. The above results indicate that IMN is effective and safe in the treatment of CPHFs, which can validly reduce the discomfort of patients and facilitate the recovery of shoulder joint function.

Incidence and Clinical Pattern of Proximal Humeral Fractures of Patients Fixed by Locking Proximal Humeral Plate (LPHP)

Incidence and Clinical Pattern of Proximal Humeral Fractures of Patients Fixed by Locking Proximal Humeral Plate (LPHP)

A Biomechanical Study of Tuberosity-Based Locked Plate Fixation Compared with Standard Proximal Humeral Locking Plate Fixation for 3-Part Proximal Humeral Fractures.

One of the main shortcomings of current proximal humeral plate designs is their inability to reliably secure the greater tuberosity (GT) or lesser tuberosity, leading to fixation failure, nonunion, and rotator cuff dysfunction. Traditional proximal humeral locking plates (PHLPs) rely on isolated screw fixation or suture repair to maintain reduction of the greater and/or lesser tuberosities. This study evaluates a tuberosity-based plate (TBP) specifically designed to improve tuberosity fixation, which may decrease tuberosity displacement and related clinical sequelae. Five cadaveric specimens (10 shoulders) were randomized to receive either standard PHLP or TBP fixation. The specimens were skeletonized except for the rotator cuff insertion on the GT. A reproducible 3-part osteotomy was performed for each cadaver, creating head, shaft, and GT segments. Anatomic reduction and plate fixation were performed according to the surgical technique guide for each plate system, with an equal number of screws placed in each plate both proximally and distally. GT fixation was enhanced with standardized suture augmentation through the rotator cuff in every specimen in both groups. In each trial, fracture displacement, load to failure, number of cycles endured, and mechanism of failure were noted. The mean load to tuberosity fixation failure for the PHLP and TBP groups was 220 and 502 N (P = 0.005), respectively. The TBP had a significantly higher load to failure and significantly lower mean fracture displacement compared with the PHLP.

Endosteal Fibular Strut Graft with Proximal Humeral Locking Plate in Delayed and Neglected Fractures of the Proximal Humerus

Purpose: The purpose of this study was to define a treatment protocol in which a non-vascularized endosteal fibular strut graft, a corticocancellous grafts and a locking plate construct are used for stabilization of the delayed and neglected proximal humerus fractures and to report its outcome. Patients & Methods: Eleven patients (6 females and 5 males) with delayed, neglected proximal humerus fractures were included in this study, conducted between March 2015 and December 2019. Average age of the patients was 57 years (range: 41 to 67 yrs). All patients were treated with the debridement, decortication and shingling of the bone at the site of the fracture followed by using an endosteal fibular strut graft, corticocancellous bone grafts and stabilization with locking plate. The patients were followed up for a mean time of 16.3 months (range: 13 to 40 months). The patient outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand Questionnaire, and the modified scoring system of Constant and Murley. Results: Union at the fracture site was achieved in all patients at a mean of 8.5 months (range: 6 to 11 months). The DASH score improved from an average pre-operative score of 71.1 (range: 64 to 78) to an average post-operative score of 25.2 (range: 21 to 35) at the final follow-up. Albeit with a small sample size of n = 11, this difference was found to be statistically significant (p 0.05). The CM score improved from an average pre-operative score of 33.2 (range: 20 to 48) to an average post-operative score of 66.8 (range: 59 to 72) at the final follow-up. This difference was also found to be statistically significant in this patient cohort (p 0.05). The results were excellent in 3 patients, good in 6 and moderate in 2. Conclusions: An endosteal fibular strut, subperiosteally placed cortico-cancellous grafts with a locking plate fixation helps in biological healing of neglected fractures of proximal humerus.

A study of long term results of the use of proximal humeral locking plates (PHLP) for the fixation of proximal humerus fractures

Background: Proximal humeral fractures are one of the commonest fractures in elderly population. They are right behind hip and distal radius fractures in incidence constituting about 1/7th of all fractures. Due to the debatable management of proximal humerus fractures in elderly population, we decided to evaluate the long term outcome of the same.Method: In this study 62 patients having proximal humerus fracture were included who were treated with locking plate fixation over a period of 4 years. Out of those patients, 51 patients who completed 3 years of follow up were evaluated for this study by using Constant Morley score (CMS). We used SPSS 16 for statistical analysis. (P 60 years age). Loss of fixation was seen more with a varus malalignment. Complications included Infection, avascular necrosis, loss of fixation, axillary nerve palsy, screw perforation of head and sub acromial impingement.Conclusion: The use of PHLP for fixation of Proximal Humerus fractures leads to reasonably good functional outcomes. It is much better than the use of non-locking plates. However the procedure requires extensive surgical skill and knowledge of mechanisms of locking plates.

Anatomic locking plates for complex proximal humeral fractures: anatomic neck fractures versus surgical neck fractures

Continued debate exists on the management of displaced 3- or 4-part proximal humeral fractures. Only a few studies have compared the efficacy of proximal humeral locking plates (PHLPs) for treating anatomic neck fractures (ANFs) and surgical neck fractures (SNFs). The medical data of 31 consecutive patients with displaced 4-part proximal humeral fractures treated with PHLPs between May 2013 and April 2015 were reviewed retrospectively. We divided the patients into the ANF and SNF groups and assessed the neck-shaft angle (NSA), sum of the screw tip-articular surface distance, and other parameters postoperatively at 3 days and at 12 months using shoulder radiographs. The Constant-Murley scores were assessed at 3 days, 12 months, and last follow-up. The ANF group had a significantly lower mean age and significantly greater mean operative duration, estimated blood loss, and rate of bone grafting. Full or partial osteonecrosis of the humeral head developed in 7 patients and 1 patient in the ANF and SNF groups, respectively. Screw cutout and/or pullout complications occurred in 8 cases in the ANF group but not in the SNF group. In the ANF group, the values for NSA and the sum of the screw tip-articular surface distance changed significantly from 3 days to 12 months postoperatively. There were no significant correlations among the tested parameters. ANFs resulted in more complications at a younger age than SNFs. ANF treatment using PHLPs is more prone to a decreased NSA and humeral head osteonecrosis and has poorer clinical outcomes than SNF treatment using PHLPs.

Relationship between the Axillary Nerve and Accompanying Vessels and Proximal Humeral Locking Plates in Japanese: An MRI Study.

We investigated the anatomical features of the axillary nerve and its accompanying vessels with respect to the lateral wall of the greater tuberosity, focusing on the relationship between the neurovascular bundle and the proximal humeral locking plates. Magnetic resonance images of 30 Japanese patients' shoulders were examined. Oblique sagittal images across the greater tuberosity and the neurovascular bundle, which contain the axillary nerve and posterior circumflex humeral artery and vein, were obtained. The distance between the superior aspect of the greater tuberosity and the superior and inferior borders of the neurovascular bundles was measured at the anterior, middle, and posterior edges of the greater tuberosity. The neurovascular bundle was 28.5-36.7 mm, 32.6-41.3 mm, and 38.1-47.5 mm distal to the superior aspect of the greater tuberosity at the anterior, middle, and posterior edges, respectively. We evaluated the relationship between the neurovascular bundle and 3 different locking plates, which were placed at the lateral aspect of the greater tuberosity. Only 3 or four locking screws at the most proximal part could be safely inserted without axillary nerve interference.

Fluoroscopic Technique for Open Reduction and Internal Fixation of Proximal Humeral Fracture Using the Proximal Humeral Locking Plate: Proposal of “Plate” and “Screw” Views

Proximal humeral fractures are common injuries with increasing incidence, particularly in the aging population. Nondisplaced or minimally displaced fractures can be treated conservatively whereas surgical fixation is usually indicated in the cases of displaced fractures. Various surgical options have been used for treatment of these fractures. Good outcomes have been reported with use of the Proximal Humeral Internal Locking System (PHILOS plate; Synthes, Zuchwil, Switzerland) as the implant of choice. However many complications have been reported, including varus malalignment, excessive retroversion of the articular part of the humerus, penetration of screws, and avascular necrosis of the humeral head. Therefore, we have hypothesized that an inadequate intraoperative fluoroscopic assessment may be an important factor contributing to these complications. We have described a step-by-step intraoperative fluoroscopic setup, including the proposal of a plate and screw view, focusing on the accuracy of reduction and proper placement of the PHILOS plate to prevent the complications previously described.

Surgical Technique for Open Reduction–Internal Fixation of an Unstable Displaced 3-Part Proximal Humeral Fracture Using a Proximal Humeral Locking Plate

The proximal humeral locking plate (PHLP) is a recently developed fixed-angle implant that is an option for open reduction–internal fixation of an unstable displaced proximal humeral fracture. Various articles have reported successful outcomes using the PHLP when compared with other implant designs. However, many complications still occur with use of the PHLP, such as avascular necrosis of the humeral articular fragment, malreduction (particularly varus malalignment), and screw penetration. These complications are related to the difficulty in fixation of this particular type of fracture, as well as ineffective surgical technique. We have therefore proposed a step-by-step surgical technique for open reduction–internal fixation of an unstable displaced 3-part proximal humeral fracture using a PHLP. This technique focuses on the precise placement of the PHLP according to the plate design, as well as an effective intraoperative assessment, to improve surgical outcomes and prevent the various complications of proximal humeral fractures.

Clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures

To explore the clinical efficacies of different internal fixation materials in the treatment of senile proximal humerus fractures. A total of 284 hospitalized patients of proximal humerus fractures over 60 years of age cases from October 2009 to February 2012 were randomly divided into two groups of locking proximal humeral plate (LPHP) and PHILOS (n = 142 each). And the clinical efficacies of two groups were compared. For PHILOS and LPHP groups, the fracture healing periods were (11.64 ± 3.81) and (14.95 ± 3.95) weeks. And there was statistical significance (P < 0.05). At 3 months post-surgery, the incidence of pain was 72.41% and 64.81%. And there was statistical significance (P < 0.05). At 2 years,Neer shoulder function score had inter-group statistically insignificant difference (P > 0.05). Both PHILOS and LPHP are effective in the treatment of senile proximal humeral fractures.However, the former is conducive to fracture healing and has shorter healing time and lowered postoperative pain.

Treatment of comminuted fractures of the proximal humerus with locking proximal humeral plate

Objective To evaluate the efficacy of locking proximal humeral plate (LPHP) for the treatment of comminuted fractures of proximal humerus in comparison with anatomical proximal humeral plate (APHP) and T-shaped plate.Methods From August 2008 to September 2010,65 patients with comminuted fracture of proximal humerus of Neer types Ⅱ-Ⅳ were treated in our department.They were 36 men and 29 women,with an average age of 39 years (from 24 to 70 years).LPHP was used in 36 patients (group A),APHP in 19 patients (group B) and T plate in 10 patients (group C).All the operations were conducted through the deltoid-pectoral-gap,and autografts were transplanted in the cases of bone defects after reduction.Exercises were done 1 to 6 weeks postoperation to prevent shoulder anchylosis.The clinical outcomes were compared between the 3 methods,including fracture healing,Neer score and complications.Results All the patients were followed up from 12 to 18 months (14.5 months on average).Fracture union was achieved in 36 cases in group A,in 17 cases in group B and in 8 cases in group C,with significant between-group differences ( P ＜ O.05).The mean healing time was 10.1 ± 1.2 weeks in group A,12.3 ± 1.4 weeks in group B and 15.4 ±2.6 weeks in group C,with significant between-group differences ( P ＜ 0.05).Humeral head necrosis occurred in 2 cases in group B and in 2 cases in group C,with a significant difference between group A and groups B and C ( P ＜ 0.05).By Neer scoring system,the good to excellent rate of shoulder function was 97.2％ in group A,63.2％ in group B and 40.0％ in group C,with significant between-group differences ( P ＜ O.05).Conclusion LPHP can be considered as the standard-therapy for comminuted fractures of proximal humerus of Neer types Ⅲ - ⅣV,because it can firmly fixate the comminuted fractures of the proximal humerus,leading to fast fracture healing,good functional recovery and limited complications. Key words: Shoulder fractures; Fractures, comminuted; Fracture fixation, internal; Bone plates

Management of proximal humeral Neer 3-part and 4-part fracture dislocations with anatomic reconstruction locking plate

Objective To analyze the therapeutic effect of open reduction with internal fixation (ORIF) and anatomic reconstruction locking plate in treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus. Methods The study involved 30 patients with Neer 3-part and 4-part fracture dislocations treated with anatomic reconstruction locking plate from September 2004 to December 2007.Twenty patients had complete follow-up data.The treatment methods included locking proximal humeral plate (LPHP) in seven patients and proximal humeral internal locking system (PHILOS) in 13.There were 15 males and five females,at age range of 29-84 years (average 52.5 years),including nine patients younger than 65 years and 11 older than 65 years.According to Neer classification,there were 15 patients with 3-part fracture dislocations including 12 anterior and three posterior dislocations and five patients with 4-part fracture dislocations including four anterior and one posterior dislocations. VAS and Constant scoring system were adopted to evaluate the shoulder joint function postoperatively. Results All 20 patients were followed up for 36-71 months ( average 51 months),which showed avascular necrosis of humeral head in six patients (30％),plating loosening in two,screw penetration in six,nonunion in two and infection in two.The mean visual analogue score (VAS) was 2.55 poiuts and the mean Constant score for the shoulder was 80.8.According to the Neer shoulder functional evaluation standard,eight patients were graded as excellent,six as good,three as fair and three as poor,with excellence rate of 70％.Conclusions Although the anatomic reconstruction locking plate and ORIF can cause a high incidence of avascular necrosis of humeral head in the treatment of Neer 3-part and 4-part fracture dislocations of proximal humerus,especially for the patients older than 65 years.However,there is no obvious correlation between necrosis of humeral head and shoulder function.Clinically,the method could be selected on the ba-sis of individual condition of the patients. Key words: Shoulder fractures; Fracture fixation, internal; Shoulder dislocation

Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures

Path analysis methods were used to test the prognostic value of 10 patient-related and treatment-related factors on the 1-year functional outcome of 463 proximal humeral fractures measured using the Constant score. Complex inter-relationships between these factors were also evaluated. Data were collected from a prospective cohort study that included 3 operative groups repaired using nail or plate fixation and 1 nonoperative group. From the available information, various factors potentially having a direct influence on the functional Constant score were identified. The process of creating a hypothetical causal path diagram was undertaken to order the factors in a sequence of associations or cause-and-effect relationships. Our final multivariable regression model for the 1-year Constant score included the 6 factors of age, sex, treatment, occurrence of intraoperative and local post-treatment complications, and anatomic restoration. Being a woman aged older than 40 years, treated with a locking proximal humeral plate (LPHP), having experienced intraoperative and local post-treatment complications, and varus deformity of more than 30° were negative predictors of the Constant score (ie, poor shoulder function 1 year after treatment initiation). Three factors, the dominant side fractured and the Neer and AO fracture type, showed only significant association on intermediate factors. The presence of concomitant disease did not show any significant direct or indirect effect. A final pathway outlines these associations and inter-relationships. Prevention of local complications, in particular those leading to severe varus deviation, appears essential to improve shoulder function after a proximal humeral fracture.

Endosteal Strut Augment Reduces Complications Associated With Proximal Humeral Locking Plates

Locking-plate technology has renewed interest in plate fixation for treating proximal humerus fractures. Complications associated with these devices, including loss of reduction, screw cutout, and intra-articular penetration, are frequent. Establishing a second column of support may reduce complications and improve clinical outcome scores. We asked whether addition of an endosteal cortical allograft strut, used as an augment to locking-plate fixation for displaced proximal humerus fractures, would reduce complications and improve clinical outcome scores. We retrospectively reviewed the charts and radiographs of 38 patients treated by this method. All patients were evaluated with serial radiographs, as well as the Disabilities of the Arm, Shoulder, and Hand and Constant-Murley scores. There were seven two-part, 19 three-part, and 12 four-part fractures. The minimum followup was 49weeks (average, 75weeks; range, 49-155weeks). No patient had intra-articular screw penetration or cutout. No patient had complete osteonecrosis, but one had partial osteonecrosis. The reduction was lost in one patient. The mean Disabilities of the Arm, Shoulder, and Hand score was 15 (range, 0-66.4). The mean Constant-Murley score was 87 (range, 51-95). Low rates of complication and high clinical outcome scores can be achieved when treating complex proximal humerus fractures with locking-plate fixation and an endosteal strut augment. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Internal fixation of proximal humeral fractures with locking proximal humeral plate (LPHP) in elderly patients with osteoporosis

BackgroundDifferent operative techniques used for treating displaced proximal humeral fractures could result in malunion, non-union, osteonecrosis of humeral head, loosening of screw and loss of reduction particularly in comminuted and osteoporotic fractures. Locking compression plate (LPHP) has been proposed for open reduction and internal fixation of these fractures and is associated with less complication rate.Materials and methodsWe prospectively assessed the functional outcome and the complications after an average follow-up of 24.9 months in 25 patients of proximal humeral fractures with osteoporosis. Mean age was 62 years. Using AO classification, 48% were type A and 52% type B.ResultsMean constant score was 80 points. According to constant score, 28% had excellent outcome, 64% had good functional outcome, and 8% had moderate outcome. When the results were related to grades of osteoporosis, grade IV osteoporotic fractures had highest average Constant–Murley score (83 points, range 78–88 points), followed by grade III osteoporotic fractures (80 points, range 71–92 points), followed by grade II osteoporotic fractures (78 points, range 66–88 points). Varus malalignment and subacromial impingement were observed in 8% patients. Loosening of implant and loss of reduction were observed in 4% patients. Superficial infection was observed in 4% patients.ConclusionsLocking compression plate (LPHP) is an advantageous implant in proximal humeral fractures due to angular stability, particularly in comminuted fractures and in osteoporotic bones in elderly patients, thus allowing early mobilization.

Clinical research on proximal humeral fractures treated by locking proximal humeral plate

To evaluate the indications and clinical results of displaced proximal humeral fractures treated by locking proximal humeral plate (LPHP). From September 2004 to March 2006, 75 patients which were treated by open reduction and internal fixation with LPHP were available to follow-up, with an average time of 17 months (12 - 30 months). There were 60 fresh fractures and 15 delayed fractures. The range of motion, muscle strength, visual analogue scale (VAS) for pain, American shoulder and elbow surgeon (ASES) score, Constant-Murley, University of California, Los Angeles (UCLA) scoring system and simple shoulder test (SST) for function evaluation were all recorded. The average forward flexion was (147.3 +/- 17.7) degrees , external rotation was (30.5 +/- 16.2) degrees and internal rotation was to T9. The mean ASES was 86.7 +/- 12.7, Constant-Murley was 87.4 +/- 10.5, UCLA was 30.1 +/- 4.2. The total good or excellent rate was 89.3%. Compare with fresh fractures, the delayed group showed significant less forward flexion and ASES (P = 0.021 and 0.036 respectively). In 9 patients with late complications, there were significant differences regarding ASES, UCLA scoring system and Constant-Murley compared with patients without any complication. With strict indication control and appropriate surgical technique, satisfactory results can be expected for the displaced proximal humeral fractures treated with locking proximal humeral plates.

Treatment of chronic rotator-cuff impingement by arthroscopic subacromial decompression.

We report a prospective study of 49 patients who had arthroscopic subacromial decompression for chronic rotator-cuff impingement. All patients were assessed preoperatively and at 3, 6 and 12 months using the modified UCLA shoulder score. The dominant arm was affected in 35 patients, but only 13 recognised overuse as a cause of their shoulder pain. Before operation, the UCLA shoulder score was poor or fair in all patients. After three months only 28% of patients had satisfactory relief of symptoms but at one year 85% of patients examined had a good or excellent result. Patients with calcific tendonitis recovered more quickly: 93% reported a good result at six months. We conclude that arthroscopic subacromial decompression is an effective form of treatment, but that patients should be warned that recovery from surgery may be prolonged.