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International Orthopaedics

Erschienen in:

07.10.2017 | Review Article

Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions

verfasst von: Tristan E. McMillan, Alan J. Johnstone

Erschienen in: International Orthopaedics | Ausgabe 8/2018

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Abstract

The surgical treatment of proximal humerus fractures remains controversial primarily due to the high complication rate associated with the available fixation methods. In an attempt to reduce the incidence of serious complications and subsequent poor clinical outcomes, proximal humerus locking plates have become popular but even these implants cannot overcome the risk of complications, especially those associated with loss of fracture reduction and screw cut-out/migration through the humeral head. In an attempt to address these issues, we have reviewed the literature, investigating the most likely causes for these predominantly mechanical complications and propose technical solutions.

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697. https://doi.org/10.1016/j.injury.2006.04.130 CrossRefPubMed

Lauritzen JB, Schwarz P, Lund B et al (1993) Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int 3:127–132. https://doi.org/10.1007/BF01623273 CrossRefPubMed

Kim SH, Szabo RM, Marder RA (2012) Epidemiology of Humerus Fractures in the United States: Nationwide Emergency Department Sample, 2008. Arthritis Care Res 64:407–414. https://doi.org/10.1002/acr.21563 CrossRef

Gupta AK, Harris JD, Erickson BJ et al (2015) Surgical management of complex proximal humerus fractures—a systematic review of 92 studies including 4500 patients. J Orthop Trauma 29:54–59CrossRefPubMed

Thanasas C, Kontakis G, Angoules A et al (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elb Surg 18:837–844. https://doi.org/10.1016/j.jse.2009.06.004 CrossRef

Sproul RC, Iyengar JJ, Devcic Z, Feeley BT (2011) A systematic review of locking plate fixation of proximal humerus fractures. Injury 42:408–413. https://doi.org/10.1016/j.injury.2010.11.058 CrossRefPubMed

Jost B, Spross C, Grehn H, Gerber C (2013) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elb Surg 22:542–549. https://doi.org/10.1016/j.jse.2012.06.008 CrossRef

Kettler M, Biberthaler P, Braunstein V et al (2006) Die winkelstabile Osteosynthese am proximalen Humerus mit der PHILOS-Platte. Unfallchirurg 109:1032–1040. https://doi.org/10.1007/s00113-006-1165-7 CrossRefPubMed

Goldhahn J, Suhm N, Goldhahn S et al (2008) Influence of osteoporosis on fracture fixation--a systematic literature review. Osteoporos Int 19:761–772. https://doi.org/10.1007/s00198-007-0515-9 CrossRefPubMed

10.

Krappinger D, Bizzotto N, Riedmann S et al (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. https://doi.org/10.1016/j.injury.2011.01.017 CrossRefPubMed

11.

Tingart MJ, Apreleva M, von Stechow D et al (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85:611–617CrossRefPubMed

12.

Newton AW, Selvaratnam V, Pydah SK, Nixon MF (2016) Simple radiographic assessment of bone quality is associated with loss of surgical fixation in patients with proximal humeral fractures. Injury 47:904–908. https://doi.org/10.1016/j.injury.2015.12.029 CrossRefPubMed

13.

Schliemann B, Wahnert D, Theisen C et al (2015) How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data. Injury 46:1207–1214. https://doi.org/10.1016/j.injury.2015.04.020 CrossRefPubMed

14.

Neer CS (1970) Displaced proximal humeral fractures. I Classification and evaluation J Bone Joint Surg Am 52:1077–1089CrossRefPubMed

15.

Berkes MB, Little MTM, Lorich DG (2013) Open reduction internal fixation of proximal humerus fractures. Curr Rev Musculoskelet Med 6:47–56. https://doi.org/10.1007/s12178-012-9150-y CrossRefPubMedPubMedCentral

16.

Solberg BD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689. https://doi.org/10.2106/JBJS.H.00133 CrossRefPubMed

17.

Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elb Surg 13:427–433. https://doi.org/10.1016/j.jse.2004.01.034 CrossRef

18.

Jung S-W, Shim S-B, Kim H-M et al (2015) Factors that influence reduction loss in proximal humerus fracture surgery. J Orthop Trauma 29:276–282. https://doi.org/10.1097/BOT.0000000000000252 CrossRefPubMed

19.

Gardner MJ, Weil Y, Barker JU et al (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21:185–191. https://doi.org/10.1097/BOT.0b013e3180333094 CrossRefPubMed

20.

Schnetzke M, Bockmeyer J, Porschke F et al (2016) Quality of reduction influences outcome after locked-plate fixation of proximal humeral type-C fractures. J Bone Jt Surg 98:1777–1785. https://doi.org/10.2106/JBJS.16.00112 CrossRef

21.

Jung W-B, Moon E-S, Kim S-K et al (2013) Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate? BMC Musculoskelet Disord 14:102. https://doi.org/10.1186/1471-2474-14-102 CrossRefPubMedPubMedCentral

22.

Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 23:113–119. https://doi.org/10.1097/BOT.0b013e31819344bf CrossRefPubMed

23.

Agudelo J, Schürmann M, Stahel P et al (2007) Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 21:676–681. https://doi.org/10.1097/BOT.0b013e31815bb09d CrossRefPubMed

24.

Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16:65–72. https://doi.org/10.1007/s00198-004-1714-2 CrossRef

25.

Helmy N, Hintermann B (2006) New trends in treatment of proximal humerus fractures. Clin Orthop Relat Res 442:100–108CrossRefPubMed

26.

Haidukewych GJ (2004) Perspectives on modern orthopaedics innovations in locking plate technology. Jaaos 12:205–212PubMed

27.

Lill H, Hepp P, Korner J et al (2003) Proximal humeral fractures: how stiff should an implant be? Arch Orthop Trauma Surg 123:74–81. https://doi.org/10.1007/s00402-002-0465-9 CrossRefPubMed

28.

Schliemann B, Hartensuer R, Koch T et al (2015) Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate. J Shoulder Elb Surg 24:1282–1288. https://doi.org/10.1016/j.jse.2014.12.028 CrossRef

29.

Schliemann B, Seifert R, Theisen C et al (2017) PEEK versus titanium locking plates for proximal humerus fracture fixation: a comparative biomechanical study in two- and three-part fractures. Arch Orthop Trauma Surg 137:63–71. https://doi.org/10.1007/s00402-016-2620-8 CrossRefPubMed

30.

Feerick EM, Kennedy J, Mullett H et al (2013) Investigation of metallic and carbon fibre PEEK fracture fixation devices for three-part proximal humeral fractures. Med Eng Phys 35:712–722. https://doi.org/10.1016/j.medengphy.2012.07.016 CrossRefPubMed

31.

Zhang W, Zeng L, Liu Y et al (2014) The mechanical benefit of medial support screws in locking plating of proximal humerus fractures. PLoS One 9:e103297. https://doi.org/10.1371/journal.pone.0103297 CrossRefPubMedPubMedCentral

32.

Ponce BA, Thompson KJ, Raghava P et al (2013) The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Jt Surgery-American 95:e113-1–e113-7. https://doi.org/10.2106/JBJS.K.00202 CrossRef

33.

Mathison C, Chaudhary R, Beaupre L et al (2010) Biomechanical analysis of proximal humeral fixation using locking plate fixation with an intramedullary fibular allograft. Clin Biomech 25:642–646. https://doi.org/10.1016/j.clinbiomech.2010.04.006 CrossRef

34.

Bae J-H, Oh J-K, Chon C-S et al (2011) The biomechanical performance of locking plate fixation with intramedullary fibular strut graft augmentation in the treatment of unstable fractures of the proximal humerus. J Bone Jt Surg [Br] 9393:937–941. https://doi.org/10.1302/0301-620X.93B7 CrossRef

35.

Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 22:195–200. https://doi.org/10.1097/BOT.0b013e31815b3922 CrossRefPubMed

36.

Panchal K, Jeong J-J, Park S-E et al (2016) Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft. Int Orthop 40:569–577. https://doi.org/10.1007/s00264-015-2950-0 CrossRefPubMed

37.

Saltzman BM, Erickson BJ, Harris JD et al (2016) Fibular strut graft augmentation for open reduction and internal fixation of proximal humerus fractures: a systematic review and the authors’ preferred surgical technique. Orthop J Sport Med 4:2325967116656829. https://doi.org/10.1177/2325967116656829 CrossRef

38.

Hettrich CM, Neviaser A, Beamer BS et al (2012) Locked plating of the proximal humerus using an endosteal implant. J Orthop Trauma 26:212–215. https://doi.org/10.1097/BOT.0b013e318243909c CrossRefPubMed

39.

Liew ASL, Johnson JA, Patterson SD et al (2000) Effect of screw placement on fixation in the humeral head. J Shoulder Elb Surg 9:423–426. https://doi.org/10.1067/mse.2000.107089 CrossRef

40.

Hall MC, Rosser M (1963) The structure of the upper end of the humerus with reference to osteoporotic changes in senescence leading to fractures. Can Med Assoc J 88:290–294PubMedPubMedCentral

41.

Tingart MJ, Lehtinen J, Zurakowski D et al (1994) Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect the fixation strength of cancellous screws. J Shoulder Elb Surg 15:620–624. https://doi.org/10.1016/j.jse.2005.09.007 CrossRef

42.

Padegimas EM, Zmistowski B, Lawrence C et al (2017) Defining optimal calcar screw positioning in proximal humerus fracture fixation. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2017.05.003

43.

Frich L, Jensen N (2014) Bone properties of the humeral head and resistance to screw cutout. Int J Shoulder Surg 8:21. https://doi.org/10.4103/0973-6042.131851 CrossRefPubMedPubMedCentral

44.

Spross C, Jost B, Rahm S et al (2014) How many radiographs are needed to detect angular stable head screw cut outs of the proximal humerus-A cadaver study. Injury 45:1557–1563. https://doi.org/10.1016/j.injury.2014.05.025 CrossRefPubMed

45.

Brunner F, Sommer C, Bahrs C et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23:163–172. https://doi.org/10.1097/BOT.0b013e3181920e5b CrossRefPubMed

46.

Erhardt JB, Stoffel K, Kampshoff J et al (2012) The position and number of screws influence screw perforation of the humeral head in modern locking plates: a cadaver study. J Orthop Trauma 26:e188–e192. https://doi.org/10.1097/BOT.0b013e31823db922 CrossRefPubMed

47.

Palumbo BT, Gutierrez S, Santoni B, Mighell M (2017) Biomechanical investigation of locked plate fixation with suture augmentation in a comminuted three-part proximal humerus fracture model. Open J Orthop 7:180–191. https://doi.org/10.4236/ojo.2017.77020 CrossRef

48.

Schliemann B, Seifert R, Rosslenbroich SB et al (2015) Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. J Shoulder Elb Surg 24:1968–1973. https://doi.org/10.1016/j.jse.2015.06.028 CrossRef

49.

Parada SA, Makani A, Stadecker MJ, Warner JJP (2015) Tips of the trade technique of open reduction and internal fixation of comminuted proximal humerus fractures with allograft femoral head metaphyseal reconstruction. Am J Orthop 44:471–475PubMed

Titel: Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions
verfasst von: Tristan E. McMillan
Alan J. Johnstone
Publikationsdatum: 07.10.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 8/2018
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3652-6

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