The authors declare that they have no competing interests.
RO was responsible for conception, design, acquisition of data and of the drafting the manuscript. VF and RB made substantial contributions to the conception of the manuscript. WH did the statistical work and was involved in designing the study as well as interpreting the results. HR, AA and TN gave final approval of the version to be published. All authors read and approved the final manuscript.
The ideal method for the surgical treatment of proximal humeral fractures has not yet been found. We therefore conducted a retrospective matched-pair analysis and compared osteosynthesis with open reduction and internal fixation and that with an angular stable plate with minimally invasive, closed reduction, percutaneous fixation with the Humerusblock.
During a study period of 3 years, we matched 30 patients treated with angular stable plates (group 1) for age, gender, fracture type and handedness (dominant or nondominant) to 30 patients treated using the Humerusblock (group 2). At a minimal follow-up of 24 months, clinical evaluation included the Constant-Murley score, the UCLA score and the Simple Shoulder Test. Subjective pain was evaluated using the VAS pain scale. Patients were asked to rate their subjective satisfaction of final outcome as excellent, good, satisfied or dissatisfied.
The mean CMS, UCLA score and SST differed significantly between groups 1 and 2 (60.9 vs 71.9, p < 0.01), (25.1 vs 29.5, p < 0.01) and (8.1 vs 9.4, p < 0.05), respectively. The VAS pain score was significantly lower in group 2 than in group 1 (1.2 vs 2.4; p < 0.01).
The mean abduction (109.7° vs 133.7°; p < 0.01) and anterior flexion (128.3° vs 145.7°; p < 0.01) were significantly worse in group 1. The mean operation time was significantly shorter in group 2 (117.3 vs 72.1, p < 0.01). Complications occurred in 30 % (group 1) and 23 % (group 2) of patients.
In this study, the functional outcome is superior in the Humerusblock group. However, the general outcome after surgical treatment of 3-and 4-part fractures is moderate, and the complication rate has to be considered, even though it can be lowered with the use of minimally invasive implants.
Rose PS, Adams CR, Torchia ME, Jacofsky DJ, Haidukewych GG, Steinmann SP. Locking plate fixation for proximal humeral fractures: initial results with a new implant. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 2007;16:202–7. CrossRef
Bogner R, Hübner C, Matis N, Auffarth A, Lederer S, Resch H. Minimally-invasive treatment of three-and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg (Br). 2008;90:1602–7. CrossRef
Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 2013;22:542–9. CrossRef
Neer 2nd CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077–89. PubMed
Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop. 1987;214:160–4. PubMed
Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomic total shoulder arthroplasty. Clin Orthop. 1981;155:7–20. PubMed
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 1994;3:347–52. CrossRef
Lill H, Hepp P, Korner J, Kassi J-P, Verheyden AP, Josten C, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg. 2003;123:74–81. PubMed
- Comparison between minimally invasive, percutaneous osteosynthesis and locking plate osteosynthesis in 3-and 4-part proximal humerus fractures
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II