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Surgical Techniques   |    
Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus PlateSurgical Technique
G. Konrad, MD1; J. Bayer, MD1; P. Hepp, MD2; C. Voigt, MD3; H. Oestern, MD4; M. Kääb, MD5; C. Luo, MD6; M. Plecko, MD7; K. Wendt, MD8; W. Köstler, MD1; N. Südkamp, MD1
1 Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. E-mail address for G. Konrad: gerhard.konrad@uniklinik-freiburg.de
2 Department of Trauma and Reconstructive Surgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
3 Orthopaedic and Trauma Surgery, Friederikenstift Hannover, Humboldtstrasse 5, 30169 Hannover, Germany
4 Orthopaedic and Trauma Surgery, General Hospital Celle, Siemensplatz 4, 29223 Celle, Germany
5 Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Schumannstrasse 20, 10117 Berlin, Germany
6 Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital affiliated to Shanghai JiaoTong University, 600 YiShan Road, Shanghai 200233, PR China
7 Trauma Surgery Hospital Graz, Göstingerstrasse 24, A-8021, Graz, Austria
8 Trauma Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 Groningen, The Netherlands
View Disclosures and Other Information
DISCLOSURE: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the AO Foundation, Davos, Switzerland. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 91-A, pp. 1320-8, June 2009
The line drawings in this article are the work of David A. Rini, MA, CMI (drini@jhmi.edu).
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Mar 01;92(Supplement 1 Part 1):85-95. doi: 10.2106/JBJS.I.01462
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Abstract

BACKGROUND: 

The treatment of unstable displaced proximal humeral fractures, especially in the elderly, remains controversial. The objective of the present prospective, multicenter, observational study was to evaluate the functional outcome and the complication rate after open reduction and internal fixation of proximal humeral fractures with use of a locking proximal humeral plate.

METHODS: 

One hundred and eighty-seven patients (mean age, 62.9 ± 15.7 years) with an acute proximal humeral fracture were managed with open reduction and internal fixation with a locking proximal humeral plate. At the three-month, six-month, and one-year follow-up examinations, 165 (88%), 158 (84%), and 155 (83%) of the 187 patients were assessed with regard to pain, shoulder mobility, and strength. The Constant score was determined at each interval, and the Disabilities of the Arm, Shoulder and Hand (DASH) score was determined for the injured and contralateral extremities at the time of the one-year follow-up.

RESULTS: 

Between three months and one year, the mean range of motion and the mean Constant score for the injured shoulders improved substantially. Twelve months after surgery, the mean Constant score for the injured side was 70.6 ± 13.7 points, corresponding to 85.1% ± 14.0% of the score for the contralateral side. The mean DASH score at the time of the one-year follow-up was 15.2 ± 16.8 points. Sixty-two complications were encountered in fifty-two (34%) of 155 patients at the time of the one-year follow-up. Twenty-five complications (40%) were related to incorrect surgical technique and were present at the end of the operative procedure. The most common complication, noted in twenty-one (14%) of 155 patients, was intraoperative screw perforation of the humeral head. Twenty-nine patients (19%) had an unplanned second operation within twelve months after the fracture.

CONCLUSIONS: 

Surgical treatment of displaced proximal humeral fractures with use of the locking proximal humeral plate that was evaluated in the present study can lead to a good functional outcome provided that the correct surgical technique is used. Because many of the complications were related to incorrect surgical technique, it behooves the treating surgeon to perform the operation correctly to avoid iatrogenic errors.

LEVEL OF EVIDENCE: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: 

"Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate. Results of a Prospective, Multicenter, Observational Study" (2009;91:1320-8).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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