OPEN VERSUS MINIMALLY INVASIVE LOCKING PLATE TECHNIQUE FOR PROXIMAL HUMERUS FRACTURES. A PROSPECTIVE MULTICENTER STUDY

Abstract

Introduction: Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis, which makes stable fixation difficult. Locking plates are intended to provide superior mechanical stability. The NCB^® -PH (Non-Contact-Bridging for the Proximal Humerus) plate is a locking plate of the latest generation that allows both open and minimally invasive (MI) application.

Methods: In a prospective multicenter study 131 patients were treated (n = 78 open, n = 53 MI). The open procedure was performed using a standard deltopectoral approach; the MI technique involved percutaneous reduction and an anterolateral deltoid split approach. Clinical and radiological follow-up was obtained 6 weeks, 3, 6 and 12 months after surgery. An iADL (instrumental activities of daily living) score was used for functional assessment, the subjective outcome was measured using VAS (Visual Analogue Scale) for pain and mobility.

Results: Improvement in function (ROM) was statistically significant in both groups (open and MI) postoperatively. Fracture type had the most significant impact on the complication rate. The most frequent complication was intraarticular screw perforation. The open treated group showed a higher complication rate. However, more C-type fractures (AO) were treated with this technique.

Conclusion: The NCB-PH is suitable as a routine method of treatment for proximal humerus fractures. Complication rate and functional outcome are comparable to the literature. The MI technique, which is limited by percutaneous fracture reduction, provides a less invasive option for patients requiring fast recovery. Complex fractures should preferably be treated with the open technique.