Abstract
Background
Functional outcomes of conservatively managed, valgus impacted proximal humeral fractures are poor. Operative fixation can improve results but can be technically challenging. We prospectively assessed outcomes following fixation of valgus unstable proximal humeral fractures with a novel hybrid fixed angle blade plate, at a minimum of 12 months follow up.
Methods
A new hybrid fixed angle blade plate design (Fx Plate, Exactech, Gainesville, USA) was used by the senior author to treat patients with displaced and potentially valgus unstable proximal humeral fractures, at our institution between November 2012 and March 2014. The study was approved by the research and development department. Outcomes were prospectively assessed using the Oxford and Constant shoulder scores and quality of life was assessed using the SF-36 questionnaire. Radiographs were taken at regular intervals to assess fracture healing.
Results
In total 12 patients were identified and included in the study. All patients had comminution of the medial calcar, with potentially valgus unstable fracture patterns. Six of the patients had two-part displaced fractures, whereas six had three and four-part fractures. One patient died for reasons unrelated to surgery and three others were lost to follow up. Average follow up after surgery was 15.4 months (Range 12–20 months). At final follow up the average Oxford Shoulder Score was 41 (35 to 48) and Constant Score 73 (60 to 87), indicating a good functional outcome of the operated side. The average physical and mental component scores of the SF-36 questionnaire were 49 and 52 respectively, suggesting a good overall quality of life. Radiographs, taken at final follow up, confirmed fracture union in all cases. No significant complications occurred following surgery.
Conclusions
Patients with displaced, potentially valgus unstable, proximal humeral fractures remain a challenging cohort to treat. Our results, however, indicate good functional and radiographic outcomes when using a novel hybrid fixed angle blade plate.
