PROXIMAL HUMERUS FRACTURES. SURGICAL TREATMENT WITH LOCKING PLATE, SEARCHING A PROTOCOL

Abstract

Introduction/Aim: Proximal humerus fractures are very common in our population, around 4–5% total fractures. Those are the most frequent humerus fractures. They affect mainly women 3:1, and this average raises as age increases also.

As a whole, these fractures are the third most common ones in our country and we assume that these injuries will increase progressively. So that, orthopedic surgeons may look for a serious treatment algorithm which optimize economical resources and give our patients the best functional results.

Our main aims, subsequently, are, firstly, get to know our clinical results in order to change those improvable aspects. Secondly, find out pre or postsurgical characteristics that affect on results. It will allow us to find out which patients/type of fracture will benefit from this locking plate, a reliable but expensive system with some usual complications.

Material and Methods: We have reviewed all proximal humerus fractures operated, in our centre, by this locking system, beginning on January 2004 and ending up on December 2008, in total, 71 cases. The variables list includes multiple presurgical (age, sex, Neer, approach) and postsurgical (radiology after surgery, complications) characteristics.

Due to the collaboration of the Research and Innovation Department, statistical studies have been applied and we have concluded some interesting findings.

Results: It seems to exist a relationship between female amb varus evolution fracture, probably, because of poor density bone, a very outstanding aspect in the evolution of any osteosynthesis.

Also, older patients suffer from more complications such as subacromial impingement, and it has no connection with its surgical reduction. Probably, for the very same reason as the mentioned before, osteoporosis.

Conclusions:

1. there is insufficient statistical evidence on this subject, but this system has shown its efficacy in treating most if the fractures, obtaining good functional results (72.8 mean Constant score).

2. every case must be studied individually, in order to indicate the most adequate treatment for each patient

3. when locking plate system is indicated because of the complexity of fracture (Neer), poor bone quality (middle aged women with risk factors for osteoporosi) or due to other particular circumstances, we should take into account the most frequent complications. Specially when patient is female and/or older than 60 years old:

   • 3a. subacromial impingement – avoidable by rigorous tubercles reduction (greater tuberculum, at least, 5 mm lower than humeral head)

   • 3b. varus displacement of humeral head – search for valgus reduction (> 120°)

   • 3c. intrarticular screw protusion – be careful with screws length

   • 3d. avascular necrosis – uncertain locking plate indication when fractures Neer V