nach oben

Erschienen in:

13.02.2018 | Original Paper

Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion

verfasst von: Stefan Quadlbauer, Georg J. Hofmann, Martin Leixnering, Rudolf Rosenauer, Thomas Hausner, Jürgen Reichetseder

Erschienen in: International Orthopaedics | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Aim of the study

The aim of this study was to evaluate union rate and clinical outcome in patients with proximal humeral nonunions treated by open reduction and locking plate fixation without bone grafting.

Methods

From 2011 to 2016, nine patients were treated using open reduction and locking plate stabilization without bone grafting. They were examined both clinically and radiologically, with a mean follow-up period of 31 months. Outcome was evaluated using pain and range of motion (ROM) parameters. In addition, self-assessment by patients was registered on the Disability of the Arm, Shoulder and Hand score, Constant-Murley Score, Oxford Shoulder Score, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. A CT scan of the shoulder was performed to analyze union.

Results

At checkup, all patients showed union in the CT scans, where the mean ROM in abduction was 139° (SD 50°), in adduction 39° (SD 8°), in forward flexion 136° (SD 40°), in extension 44° (SD 11°), in internal rotation 62° (SD 15°), and external rotation 54° (SD 31°). ROM improved significantly in all planes of motion, except for adduction, post-surgery (p < 0.05). Plate removal was necessary in three patients. No complications were reported.

Conclusion

Open reduction and locking plate fixation without bone grafting is a reasonable and safe option for treating proximal humerus nonunion. It leads to a high union rate, significant improvement in ROM, and in the majority of the cases to an “excellent” and “good” functional outcome without an increased risk of complications.

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

Roux A, Decroocq L, El Batti S et al (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719. https://doi.org/10.1016/j.otsr.2012.05.013 CrossRefPubMed

Alentorn-Geli E, Guirro P, Santana F, Torrens C (2014) Treatment of fracture sequelae of the proximal humerus: comparison of hemiarthroplasty and reverse total shoulder arthroplasty. Arch Orthop Trauma Surg 134:1545–1550. https://doi.org/10.1007/s00402-014-2074-9 CrossRefPubMed

Baron JA, Barrety JA, Karagas MR (1996) The epidemiology of peripheral fractures. Bone 18:209S–213S. https://doi.org/10.1016/8756-3282(95)00504-8 CrossRefPubMed

Shi HF, Xiong J, Chen YX et al (2011) Management of proximal humeral fractures in elderly patients with uni- or polyaxial locking osteosynthesis system. Arch Orthop Trauma Surg 131:541–547. https://doi.org/10.1007/s00402-010-1199-8 CrossRefPubMed

Nguyen TV, Center JR, Sambrook PN, Eisman JA (2001) Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo osteoporosis epidemiology study. Am J Epidemiol 153:587–595. https://doi.org/10.1093/aje/153.6.587 CrossRefPubMed

Panchal K, Jeong JJ, Park SE 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

Haasters F, Siebenbürger G, Helfen T et al (2016) Complications of locked plating for proximal humeral fractures—are we getting any better? J Shoulder Elb Surg 25:e295–e303. https://doi.org/10.1016/j.jse.2016.02.015 CrossRef

Südkamp N, Bayer J, Hepp P et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91:1320–1328. https://doi.org/10.2106/JBJS.H.00006 CrossRefPubMed

10.

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

11.

Sanders RJ, Thissen LG, Teepen JC et al (2011) Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elb Surg 20:1118–1124. https://doi.org/10.1016/j.jse.2011.01.025 CrossRef

12.

Keser S, Bölükbaşi S, Bayar A et al (2004) Proximal humeral fractures with minimal displacement treated conservatively. Int Orthop 28:231–234. https://doi.org/10.1007/s00264-004-0552-3 CrossRefPubMedPubMedCentral

13.

Clavert P, Adam P, Bevort A et al (2010) Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elb Surg 19:489–494. https://doi.org/10.1016/j.jse.2009.09.005 CrossRef

14.

Neer CS (1970) Displaced proximal humeral fractures. II Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52:1090–1103CrossRefPubMed

15.

Falez F, Papalia M, Greco A et al (2016) Minimally invasive plate osteosynthesis in proximal humeral fractures: one-year results of a prospective multicenter study. Int Orthop 40:579–585. https://doi.org/10.1007/s00264-015-3069-z CrossRefPubMed

16.

Konrad G, Audigé L, Lambert S et al (2012) Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures. Clin Orthop Relat Res 470:602–609CrossRefPubMed

17.

Tepass A, Blumenstock G, Weise K et al (2013) Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elb Surg 22:e8–14. https://doi.org/10.1016/j.jse.2012.04.002

18.

Oh HK, Cho DY, Choo SK et al (2015) Lessons learned from treating patients with unstable multifragmentary fractures of the proximal humerus by minimal invasive plate osteosynthesis. Arch Orthop Trauma Surg 135:235–242. https://doi.org/10.1007/s00402-014-2138-x CrossRefPubMed

19.

Quadlbauer S, Leixnering M, Jurkowitsch J et al (2017) Volar Radioscapholunate arthrodesis and distal Scaphoidectomy after Malunited distal radius fractures. J Hand Surg Am 42:754.e1–754.e8. https://doi.org/10.1016/j.jhsa.2017.05.031 CrossRef

20.

Konrad G, Hirschmüller A, Audige L et al (2012) Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures - results of an international multicentre study. Int Orthop 36:1051–1058. https://doi.org/10.1007/s00264-011-1410-8 CrossRefPubMed

21.

Bouchet R, Block D, D’ollonne T et al (2016) Non-operative treatment of four-part fractures of the proximal end of the humerus: results of a prospective and retrospective multicentric study. Int Orthop 40:1669–1674. https://doi.org/10.1007/s00264-015-3090-2 CrossRefPubMed

22.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2016) Early rehabilitation of distal radius fractures stabilized by volar locking plate: a prospective randomized pilot study. J Wrist Surg 6:102–112. https://doi.org/10.1055/s-0036-1587317 CrossRefPubMedPubMedCentral

23.

Quadlbauer S, Pezzei C, Jurkowitsch J et al (2017) Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 137:579–584. https://doi.org/10.1007/s00402-017-2659-1 CrossRefPubMed

24.

Erhardt JB, Roderer G, Grob K et al (2009) Early results in the treatment of proximal humeral fractures with a polyaxial locking plate. Arch Orthop Trauma Surg 129:1367–1374. https://doi.org/10.1007/s00402-009-0924-7 CrossRefPubMed

25.

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

26.

Hauschild O, Konrad G, Audige L et al (2013) Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus. Arch Orthop Trauma Surg 133:1385–1393. https://doi.org/10.1007/s00402-013-1798-2 CrossRefPubMed

27.

McMillan TE, Johnstone AJ (2017) Primary screw perforation or subsequent screw cut-out following proximal humerus fracture fixation using locking plates: a review of causative factors and proposed solutions. Int Orthop 7. https://doi.org/10.1007/s00264-017-3652-6

28.

Berkes MB, Little MTM, Lazaro LE et al (2014) Intramedullary allograft fibula as a reduction and fixation tool for treatment of complex proximal humerus fractures with diaphyseal extension. J Orthop Trauma 28:e56–e64. https://doi.org/10.1097/BOT.0b013e31829a346d CrossRefPubMed

29.

Tan E, Lie D, Wong MK (2014) Early outcomes of proximal Humerus fracture fixation with locking plate and intramedullary fibular strut graft. Orthopedics 37:e822–e827. https://doi.org/10.3928/01477447-20140825-60 CrossRefPubMed

30.

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

31.

Warner J, Coustouros J, Gerber C (2015) Fractures of the proximal Humerus. In: Bucholz R, Heckman J, Court-Brown C (eds) Rockwood Green’s Fract. Adults, 6th edn. Lippincott Williams and Wilkins, Philadelphia, pp 1161–1210

32.

Court-Brown CM, McQueen MM (2008) Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma - Inj Infect Crit Care 64:1517–1521. https://doi.org/10.1097/TA.0b013e3181469840 CrossRef

33.

Badman BL, Mighell M, Kalandiak SP, Prasarn M (2009) Proximal humeral nonunions treated with fixed-angle locked plating and an intramedullary strut allograft. J Orthop Trauma 23:173–179. https://doi.org/10.1097/BOT.0b013e31819b0bdc CrossRefPubMed

34.

Neer II CS (1990) Shoulder reconstruction. In: Neer II CS (eds) Shoulder reconstruction. WB Saunder, Philadelphia, pp 230-234

35.

Norris TR, Turner JA, Bovill D (1990) Nonunion of the upper humerus: an analysis of the etiology and treatment in 28 cases. Mosby Year Book Inc, Chicago

36.

Yamane S, Suenaga N, Oizumi N, Minami A (2008) Interlocking intramedullary nailing for nonunion of the proximal humerus with the straight nail system. J Shoulder Elb Surg 17:755–759. https://doi.org/10.1016/j.jse.2008.02.006 CrossRef

37.

Healy WL, Jupiter JB, Kristiansen TK, White RR (1990) Nonunion of the proximal humerus. A review of 25 cases. J Orthop Trauma 4:424–431CrossRefPubMed

38.

Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ (1995) Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Relat Res 313:200–205

39.

Allende C, Allende BT (2009) The use of a new locking 90° blade plate in the treatment of atrophic proximal humerus nonunions. Int Orthop 33:1649–1654. https://doi.org/10.1007/s00264-008-0686-9 CrossRefPubMed

40.

Spitzer AB, Davidovitch RI, Egol KA (2009) Use of a “hybrid” locking plate for complex metaphyseal fractures and nonunions about the humerus. Injury 40:240–244. https://doi.org/10.1016/j.injury.2008.07.019 CrossRefPubMed

41.

Martinez AA, Bejarano C, Carbonel I et al (2012) The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty. Injury 43 Suppl 2:S3–6. https://doi.org/10.1016/S0020-1383(13)70172-4

42.

Dezfuli B, King JJ, Farmer KW et al (2016) Outcomes of reverse total shoulder arthroplasty as primary versus revision procedure for proximal humerus fractures. J Shoulder Elb Surg 25:1133–1137. https://doi.org/10.1016/j.jse.2015.12.002 CrossRef

43.

Galatz LM, Williams GR, Fenlin JM et al (2004) Outcome of open reduction and internal fixation of surgical neck nonunions of the humerus. J Orthop Trauma 18:63–67. https://doi.org/10.1097/00005131-200402000-00001 CrossRefPubMed

44.

Weber BG, Čech O (1976) Pseudarthrosis: pathophysiology, biomechanics, therapy, results. Grune & Stratton, New York, pp 14–28

45.

Müller ME, Koch P, Nazarian S, Schatzker J (1990) The comprehensive classification of fractures of long bones. In: Compr Classif Fract long bones. Springer, Berlin Heidelberg, pp 148–191

46.

NEER CS (1970) Displaced proximal humeral fractures. J Bone Joint Surg Am 52:1090–1103. https://doi.org/10.2106/00004623-197052060-00002 CrossRefPubMed

47.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 29:602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L CrossRefPubMed

48.

Constant CR, Murley AH (1987) A Clinical Method of Functional Assessment of the Shoulder. Clin Orthop Relat Res 214:160–164. https://doi.org/10.1097/00003086-198701000-00023 CrossRef

49.

Huber W, Hofstaetter JG, Hanslik-Schnabel B et al (2004) The German version of the Oxford shoulder score cross-cultural adaptation and validation. Arch Orthop Trauma Surg 124:531–536. https://doi.org/10.1007/s00402-004-0716-z CrossRefPubMed

50.

Michener LA, McClure PW, Sennett BJ (2002) American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elb Surg 11:587–594. https://doi.org/10.1067/mse.2002.127096 CrossRef

51.

Ring D, McKee MD, Perey BH, Jupiter JB (2001) The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus. J Shoulder Elb Surg 10:501–507. https://doi.org/10.1067/mse.2001.118414 CrossRef

52.

Zhang L, Zheng J, Wang W et al (2011) The clinical benefit of medial support screws in locking plating of proximal humerus fractures: a prospective randomized study. Int Orthop 35:1655–1661. https://doi.org/10.1007/s00264-011-1227-5 CrossRefPubMedPubMedCentral

53.

Nowak LL, Vicente MR, McKee MD et al (2017) Orthopaedic surgeons’ opinions surrounding the management of proximal humerus fractures: an international survey. Int Orthop 41:1749–1755. https://doi.org/10.1007/s00264-017-3569-0 CrossRefPubMed

54.

Sosef N, van Leerdam R, Ott P et al (2010) Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients. Arch Orthop Trauma Surg 130:605–611. https://doi.org/10.1007/s00402-009-1027-1 CrossRefPubMed

55.

Charalambous CP, Siddique I, Valluripalli K et al (2007) Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg 127:205–210. https://doi.org/10.1007/s00402-006-0256-9 CrossRefPubMed

56.

Greiner S, Uschok S, Herrmann S et al (2014) The metaphyseal bone defect predicts outcome in reverse shoulder arthroplasty for proximal humerus fracture sequelae. Arch Orthop Trauma Surg 134:755–764. https://doi.org/10.1007/s00402-014-1980-1 CrossRefPubMed

57.

Neviaser AS, Hettrich CM, Dines JS, Lorich DG (2011) Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant. Arch Orthop Trauma Surg 131:1617–1622. https://doi.org/10.1007/s00402-011-1366-6 CrossRefPubMed

58.

Duralde XA, Flatow EL, Pollock RG et al (1996) Operative treatment of nonunions of the surgical neck of the humerus. J Shoulder Elb Surg 5:169–180. https://doi.org/10.1016/S1058-2746(05)80002-3 CrossRef

59.

LEACH RE, PREMER RF (1965) Nonunion of the surgical neck of the Humerus. Method of internal fixation. Minn Med 48:318–322PubMed

60.

Walch G, Badet R, Nové-Josserand L, Levigne C (1996) Nonunions of the surgical neck of the humerus: surgical treatment with an intramedullary bone peg, internal fixation, and cancellous bone grafting. J Shoulder Elb Surg 5:161–168. https://doi.org/10.1016/S1058-2746(05)80001-1 CrossRef

61.

Zafra M, Uceda P, Flores M, Carpintero P (2014) Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus. Bone Joint J 96–B:1239–1243. https://doi.org/10.1302/0301-620X.96B9.33157 CrossRefPubMed

62.

Checchia SL, Miyazaki AN, Fregoneze M et al (2009) Pseudarthrosis of the Humeral Neck: Analysis of the Results When Using the Technique Described By Walch Et Al. Rev Bras Ortop (English Ed) 44:239–246. https://doi.org/10.1016/S2255-4971(15)30074-4 CrossRef

63.

Jupiter JB, Mullaji AB (1994) Blade plate fixation of proximal humeral non-unions. Injury 25:301–303. https://doi.org/10.1016/0020-1383(94)90240-2 CrossRefPubMed

64.

Little MTM, Berkes MB, Schottel PC et al (2014) The impact of preoperative coronal plane deformity on proximal humerus fixation with endosteal augmentation. J Orthop Trauma 28:338–347. https://doi.org/10.1097/BOT.0000000000000012 CrossRefPubMed

65.

Somasundaram K, Huber CP, Babu V, Zadeh H (2013) Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates. Injury 44:481–487. https://doi.org/10.1016/j.injury.2012.10.030 CrossRefPubMed

66.

Gao K, Gao W, Huang J et al (2012) Treatment of surgical neck nonunions of the humerus with locked plate and autologous fibular strut graft. Med Princ Pract 21:483–487. https://doi.org/10.1159/000337438 CrossRefPubMed

67.

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

68.

Mansat P, Bonnevialle N (2015) Treatment of fracture sequelae of the proximal humerus: anatomical vs reverse shoulder prosthesis. Int Orthop 39:349–354. https://doi.org/10.1007/s00264-014-2651-0 CrossRefPubMed

69.

Raiss P, Bradley Edwards T, Da Silva MR et al (2014) Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (Type3 fracture Sequelae). J Bone Joint Surg Am 96:2070–2076. https://doi.org/10.2106/JBJS.N.00405 CrossRefPubMed

70.

Antuña SA, Sperling JW, Sánchez-Sotelo J, Cofield RH (2002) Shoulder arthroplasty for proximal humeral nonunions. J Shoulder Elb Surg 11:114–121. https://doi.org/10.1067/mse.2002.120914 CrossRef

71.

Duquin TR, Jacobson JA, Sanchez-Sotelo J et al (2012) Unconstrained shoulder Arthroplasty for treatment of proximal humeral nonunions. J Bone Joint Surg Am 94:1610–1617. https://doi.org/10.2106/JBJS.J.01975 CrossRefPubMed

72.

Klepps S (2014) Is the reverse shoulder prosthesis for proximal humeral nonunions really worth the risk? J Bone Joint Surg Am 202:2–3. https://doi.org/10.1016/S0021-9355(14)74492-3 CrossRef

Titel: Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion
verfasst von: Stefan Quadlbauer
Georg J. Hofmann
Martin Leixnering
Rudolf Rosenauer
Thomas Hausner
Jürgen Reichetseder
Publikationsdatum: 13.02.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 9/2018
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3820-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Open reduction and fixation with a locking plate without bone grafting is a reasonable and safe option for treating proximal humerus nonunion

Abstract

Aim of the study

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Aim of the study

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2018

High-volume surgeons and high-volume journals in a multivariate orthopedic environment

Re-admissions treble the risk of late mortality after primary total hip arthroplasty

Soft tissue tension is four times lower in the unstable primary total hip arthroplasty: does this comparison make sense?

The incidence of hip dislocation and suture failure according to two different types of posterior soft tissue repair techniques in total hip arthroplasty: a prospective randomized controlled trial

Characteristics and outcomes of obstetric brachial plexus palsy in a single Saudi centre King Faisal Specialists Hospital and Research Centre: an experience of ten years

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Brustkrebs in der Vorgeschichte macht Gelenkersatz komplikationsträchtiger

Zwei neue Alternativen zu TNF-Inhibitoren bei axSpA

Update Orthopädie und Unfallchirurgie