EARLY EXPERIENCE WITH THE LOCKING PROXIMAL HUMERUS PLATE AS FIXATION FOR PROXIMAL HUMERUS IN THREE AND FOUR PART FRACTURES.

Abstract

We reviewed the results of sixteen patients with three and four part proximal humerus fractures treated with the Locking Proximal Humerus Plate (LPHP) in two trauma centres. All fractures were radiographically healed by six weeks. We found a high rate of fixation failure 4/16 cases within two weeks of surgery and range of motion results similar to previously reported techniques. This device has not demonstrated its clear superiority when used in trauma centres which commonly treat proximal humerus fractures. A randomised control trial comparing it to classical techniques and using outcome-based measures would seem appropriate.

Proximal humerus fractures with poor functional outcomes are expected to increase in frequency owing to an active ageing population. New angle stable devices have been developed to address the frequently associated osteoporosis and loss of fixation.

This study reviews the early experience of fixation with an angle stable device, the LPHP (Synthes Canada).

Three and four part fractures treated with the LPHP were identified from the database of two trauma centres. Demographics, patient activity level, mechanism of injury, fracture type were collected. Early complications, maintenance of reduction, and ROM were reviewed.

Sixteen fractures treated with the LPHP. Male to female ratio was 1.3:1. Mean age was 51.5 (29–77) Activity: 12/16 sedentary, 4/16 manual labourers. Mechanism: four Low and twelve High-energy injuries. Fracture classification: Five three part, and Eleven four part fractures.

Early complications: one wound haematoma,one re-operation for intra-articular hardware, and four of sixteen pts pulled off the greater tuberosity fixation within two weeks of surgery. Union was achieved in all sixteen by six weeks. The mean forward elevation was 60° at six weeks and 80° at three months.

This review of the early experience with the LPHP shows a significant rate of fixation failure (4/16 cases) and functional ROM results similar to other previously described techniques. Although a “learning curve effect” is possible, this device has not demonstrated clear superiority with surgeons who commonly treat proximal humerus fractures. A randomised control trial comparing it to classical techniques would seem appropriate.