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Erschienen in: Clinical Orthopaedics and Related Research® 11/2009

01.11.2009 | Original Article

Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?

verfasst von: G. Gradl, MD, PhD, A. Dietze, MD, M. Kääb, MD, PhD, W. Hopfenmüller, MD, PhD, T. Mittlmeier, MD, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 11/2009

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Abstract

The optimal surgical treatment of displaced proximal humeral fractures is controversial. New implants providing angular stability have been introduced to maintain the intraoperative reduction. In a multi-institutional study, we prospectively enrolled and followed 152 patients with unilateral displaced and unstable proximal humeral fractures treated either with an antegrade angular and sliding stable proximal interlocking nail or an angular stable plate. Fractures were classified according to the Neer four-segment classification. Clinical, functional, and radiographic followups were performed 3, 6, and 12 months after surgery. Absolute and relative (to the contralateral shoulder) Constant-Murley scores were used to assess postoperative shoulder function. Using age, gender, and fracture type, we identified 76 pairs (152 patients) for a matched-pairs analysis. Relative Constant-Murley scores 12 months after treatment with an angular and sliding stable nail and after plate fixation were 81% and 77%, respectively. We observed no differences between the two groups. Stabilization of displaced proximal humeral fractures with either an angular stable intramedullary or an extramedullary implant seems suitable with both surgical treatment options.
Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literatur
1.
Zurück zum Zitat Adedapo AO, Ikpeme JO. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury. 2001;32:115–121.PubMedCrossRef Adedapo AO, Ikpeme JO. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury. 2001;32:115–121.PubMedCrossRef
2.
Zurück zum Zitat Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741–745.PubMedCrossRef Bjorkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75:741–745.PubMedCrossRef
3.
Zurück zum Zitat Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMed Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMed
4.
Zurück zum Zitat Dimakopoulos P, Panagopoulos A, Kasimatis G. Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am. 2009;91:8–21.PubMedCrossRef Dimakopoulos P, Panagopoulos A, Kasimatis G. Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am. 2009;91:8–21.PubMedCrossRef
5.
Zurück zum Zitat Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.PubMedCrossRef Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.PubMedCrossRef
6.
Zurück zum Zitat Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.PubMedCrossRef Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.PubMedCrossRef
7.
Zurück zum Zitat Gardner MJ, Griffith MH, Dines JS, Lorich D. A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis. 2004;62:18–23.PubMed Gardner MJ, Griffith MH, Dines JS, Lorich D. A minimally invasive approach for plate fixation of the proximal humerus. Bull Hosp Jt Dis. 2004;62:18–23.PubMed
8.
Zurück zum Zitat Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg. 1998;7:586–590.PubMedCrossRef Gerber C, Hersche O, Berberat C. The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg. 1998;7:586–590.PubMedCrossRef
9.
Zurück zum Zitat Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–845.CrossRef Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–845.CrossRef
10.
Zurück zum Zitat Gierer P, Simon C, Gradl G, Ewert A, Vasarhelyi A, Beck M, Mittlmeier T. [Complex proximal humerus fractures: management with a humeral head prosthesis?] [in German]. Orthopäde. 2006;35:834–840.PubMedCrossRef Gierer P, Simon C, Gradl G, Ewert A, Vasarhelyi A, Beck M, Mittlmeier T. [Complex proximal humerus fractures: management with a humeral head prosthesis?] [in German]. Orthopäde. 2006;35:834–840.PubMedCrossRef
11.
Zurück zum Zitat Gilchrist DK. A Stockinette-Vaelpeau for immobilization of the shoulder girdle. J Bone Joint Surg Am. 1967;49:750–751.PubMed Gilchrist DK. A Stockinette-Vaelpeau for immobilization of the shoulder girdle. J Bone Joint Surg Am. 1967;49:750–751.PubMed
12.
Zurück zum Zitat Gradl G, Dietze A, Arndt D, Beck M, Gierer P, Börsch T, Mittlmeier T. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:937–944.PubMedCrossRef Gradl G, Dietze A, Arndt D, Beck M, Gierer P, Börsch T, Mittlmeier T. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:937–944.PubMedCrossRef
13.
Zurück zum Zitat Habermeyer P. [Fracture of the head of the humerus] [in German]. Unfallchirurg. 1997;100:820–837.PubMedCrossRef Habermeyer P. [Fracture of the head of the humerus] [in German]. Unfallchirurg. 1997;100:820–837.PubMedCrossRef
14.
Zurück zum Zitat Hessler C, Schmucker U, Matthes G, Ekkernkamp A, Gütschow R, Eggers C. [Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate] [in German]. Unfallchirurg. 2006;109:867–874.PubMedCrossRef Hessler C, Schmucker U, Matthes G, Ekkernkamp A, Gütschow R, Eggers C. [Results after treatment of instable fractures of the proximal humerus using a fixed-angle plate] [in German]. Unfallchirurg. 2006;109:867–874.PubMedCrossRef
15.
Zurück zum Zitat Hessmann MH, Blum J, Hofmann A, Küchle R, Rommens PM. Internal fixation of proximal humeral fractures: current concepts. Eur J Trauma. 2003;29:253–261.CrossRef Hessmann MH, Blum J, Hofmann A, Küchle R, Rommens PM. Internal fixation of proximal humeral fractures: current concepts. Eur J Trauma. 2003;29:253–261.CrossRef
16.
Zurück zum Zitat Hessmann MH, Hansen WS, Krummenauer F, Rommens PM. Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma. 2005;58:1194–1201.PubMedCrossRef Hessmann MH, Hansen WS, Krummenauer F, Rommens PM. Locked plate fixation and intramedullary nailing for proximal humerus fractures: a biomechanical evaluation. J Trauma. 2005;58:1194–1201.PubMedCrossRef
17.
Zurück zum Zitat Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82:1107–1112.PubMedCrossRef Hintermann B, Trouillier HH, Schäfer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82:1107–1112.PubMedCrossRef
18.
Zurück zum Zitat Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate: presentation of 225 cases of dislocated fractures] [in German]. Unfallchirurg. 2006;109:1032–1040.PubMedCrossRef Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate: presentation of 225 cases of dislocated fractures] [in German]. Unfallchirurg. 2006;109:1032–1040.PubMedCrossRef
19.
Zurück zum Zitat Kollig E, Kutscha-Lissberg F, Roetman B, Mielke E, Muhr G, Hahn MP. [Primary hemiarthroplasty after complex fracture of the humeral head: functional late results] [in German]. Zentralbl Chir. 2003;128:125–130.PubMedCrossRef Kollig E, Kutscha-Lissberg F, Roetman B, Mielke E, Muhr G, Hahn MP. [Primary hemiarthroplasty after complex fracture of the humeral head: functional late results] [in German]. Zentralbl Chir. 2003;128:125–130.PubMedCrossRef
20.
Zurück zum Zitat Krivohlavek M, Lukas R, Taller S, Sram J. [Use of angle-stable implants for proximal humeral fractures: prospective study] [in Czech]. Acta Chir Orthop Traumatol Cech. 2008;75:212–220.PubMed Krivohlavek M, Lukas R, Taller S, Sram J. [Use of angle-stable implants for proximal humeral fractures: prospective study] [in Czech]. Acta Chir Orthop Traumatol Cech. 2008;75:212–220.PubMed
21.
Zurück zum Zitat Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN. 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 Lill H, Hepp P, Korner J, Kassi JP, Verheyden AP, Josten C, Duda GN. 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
22.
Zurück zum Zitat Lill H, Hepp P, Rose T, König K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach: technique and first results] [in German]. Zentralbl Chir. 2004;129:43–48.PubMedCrossRef Lill H, Hepp P, Rose T, König K, Josten C. [The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach: technique and first results] [in German]. Zentralbl Chir. 2004;129:43–48.PubMedCrossRef
23.
Zurück zum Zitat Lill H, Josten C. [Conservative or operative treatment of humeral head fractures in the elderly?] [in German]. Chirurg. 2001;72:1224–1234.PubMedCrossRef Lill H, Josten C. [Conservative or operative treatment of humeral head fractures in the elderly?] [in German]. Chirurg. 2001;72:1224–1234.PubMedCrossRef
24.
Zurück zum Zitat Mathews J, Lobenhoffer P. [The Targon® PH Nail as an internal fixator for unstable fractures of the proximal humerus] [in German]. Oper Orthop Traumatol. 2007;19:255–275.PubMedCrossRef Mathews J, Lobenhoffer P. [The Targon® PH Nail as an internal fixator for unstable fractures of the proximal humerus] [in German]. Oper Orthop Traumatol. 2007;19:255–275.PubMedCrossRef
25.
Zurück zum Zitat Mittlmeier TW, Stedtfeld HW, Ewert A, Beck M, Frosch B, Gradl G. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon-PH). J Bone Joint Surg Am. 2003;85(suppl 2):136–146.PubMed Mittlmeier TW, Stedtfeld HW, Ewert A, Beck M, Frosch B, Gradl G. Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon-PH). J Bone Joint Surg Am. 2003;85(suppl 2):136–146.PubMed
26.
Zurück zum Zitat Neer CS. Displaced proximal humeral fractures. II. Treatment of three part and four part displacement. J Bone Joint Surg Am. 1970;52:1090–1103.PubMed Neer CS. Displaced proximal humeral fractures. II. Treatment of three part and four part displacement. J Bone Joint Surg Am. 1970;52:1090–1103.PubMed
27.
Zurück zum Zitat Neer CS. Four-segment classification of proximal humeral fractures. J Shoulder Elbow Surg. 2002;11:389–400.PubMedCrossRef Neer CS. Four-segment classification of proximal humeral fractures. J Shoulder Elbow Surg. 2002;11:389–400.PubMedCrossRef
29.
30.
Zurück zum Zitat Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.PubMedCrossRef Resch H, Povacz P, Fröhlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.PubMedCrossRef
31.
Zurück zum Zitat Sonderegger J, Simmen HP. [Epidemiology treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area] [in German]. Zentralbl Chir. 2003;128:119-124.PubMedCrossRef Sonderegger J, Simmen HP. [Epidemiology treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area] [in German]. Zentralbl Chir. 2003;128:119-124.PubMedCrossRef
32.
Zurück zum Zitat Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B. [Fixation of humeral head fractures with antegrade intramedullary nailing] [in German]. Zentralbl Chir. 2003;128:6–11.PubMedCrossRef Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B. [Fixation of humeral head fractures with antegrade intramedullary nailing] [in German]. Zentralbl Chir. 2003;128:6–11.PubMedCrossRef
33.
Zurück zum Zitat Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: tips and tricks. Eur J Trauma Emerg Surg. 2007;4:367–374.CrossRef Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: tips and tricks. Eur J Trauma Emerg Surg. 2007;4:367–374.CrossRef
34.
Zurück zum Zitat Tamai K, Ohno W, Takemura M, Mashitori H, Hamada J, Saotome K. Treatment of proximal humeral fractures with an intramedullary nail. J Orthop Sci. 2005;10:180–186.PubMedCrossRef Tamai K, Ohno W, Takemura M, Mashitori H, Hamada J, Saotome K. Treatment of proximal humeral fractures with an intramedullary nail. J Orthop Sci. 2005;10:180–186.PubMedCrossRef
35.
Zurück zum Zitat Wijgman AJ, Roolker W, Patt T, Raaymakers E, Marti R. Open reduction internal fixation of three and four part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.PubMed Wijgman AJ, Roolker W, Patt T, Raaymakers E, Marti R. Open reduction internal fixation of three and four part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.PubMed
36.
Zurück zum Zitat Zyto K, Kronberg M, Brostrom LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 1995;4:331–336.PubMedCrossRef Zyto K, Kronberg M, Brostrom LA. Shoulder function after displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 1995;4:331–336.PubMedCrossRef
Metadaten
Titel
Is Locking Nailing of Humeral Head Fractures Superior to Locking Plate Fixation?
verfasst von
G. Gradl, MD, PhD
A. Dietze, MD
M. Kääb, MD, PhD
W. Hopfenmüller, MD, PhD
T. Mittlmeier, MD, PhD
Publikationsdatum
01.11.2009
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 11/2009
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-0916-5

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