Abstract
Background
Peri-prosthetic humerus fractures are relatively uncommon occurrences that can be difficult to manage non-operatively. Locking plate technology has enhanced the surgical management of these fractures. We describe an osteosynthesis technique utilizing a locking plate with eccentrically placed screw holes to place “skive screws” in the proximal end of the plate to achieve fixation around the stem of the implant.
Methods
A retrospective review of prospectively collected data was performed for a consecutive series of patients treated with this skive screw technique from May 2011 to September 2014. Seven patients presented with postoperative type B peri-prosthetic humerus fractures. Average follow-up was 24 months. Radiographic analysis was performed on most recent postoperative imaging. Clinical outcomes were assessed using VAS pain, ASES total score, ASES functional score, SST, SANE, range of motion and strength.
Results
At an average of follow-up of 24 months, all patients demonstrated fracture healing. Functional outcomes were limited with only two patients achieving forward elevation above 90 degrees and average ASES Function score was 27.5. Pain relief was nearly uniform with an average VAS Pain score of 0.5 (Figure 1).
Conclusions
Peri-prosthetic humeral shaft fractures can be successfully treated with hybrid fixation technique using a locking plate with eccentric holes that facilitate placement of proximal “skive screws”. Using this technique, a 100% union rate was observed with excellent pain relief.
