049 THE DISPLACED PROXIMAL HUMERUS FRACTURE – TREATMENT WITH LOCKING-SCREW FIXED ANGLE PLATE

Abstract

The treatment of the displaced proximal humerus-fracture with solid osteosynthesis is complicating by coexistence of osteoporosis and simultaneous degenerative changes of the rotator cuff. These specific problems, as well as the usage of primary endoprosthetic replacement should be reduced through the introduction of locking-screw-plate-systems.

From April 2006 to March 2008, 70 patients received the clinical application of a newly developed locking-screw-plate (Winsta PH) in a prospective study. 48 of 70 patients were subjected to re-examination after averagely 15 months (1–3 years), 34 women and 14 men. The average age was 68.7 years. The classification of the fractures occurred after Neer. Concerned are 12 two-fragment, 21 three-fragment and 15 four-fragment fractures. The functional result after surgery was rated according to the Constant- and Dash-Score.

The average absolute Constant-Score was 63% and the Dash-score 18.3. Patients with accurate anatomical reduction achieved a significantly better score. Secondary loss of correction occurred in 3 patients with collapse of the humeral-head and perforation of the screws. An early metal removal combined with subacromial decompression took place in 3 patients, because of post-traumatic impingement. In a Neer VI-fracture-case, an early revision to hemiarthroplasty occurred due to a postoperative dislocation. One postop-wound discharge was surgically debrided.

Modern locking-screw systems like Winsta-PH plate allow a safe treatment of complex fractures of the proximal humerus, diminishing the need for primary endoprosthetic replacement significantly. Anatomic reduction is essential for the locking screw plate system to form the pillar for a successful outcome.