PROXIMAL HUMERAL FRACTURES TREATED
WITH LOCKED PLATING AND AN
INTRAMEDULLARY STRUT ALLOGRAFT:
A RETROSPECTIVE ANALYSIS
• BRIAN BADMAN MD
• PAID CONSULTANT, ROYALTIES, INVESTOR UPEX
• PAID CONSULTANT DJO SURGICAL
• JONATHAN LEVY MD
• PAID CONSULTANT DJO SURGICAL, ARTHREX, STRYKER ORTHOPAEDICS
• RANDALL OTTO MD
• HONORARIUM DJO SURGICAL
• MARK MIGHELL MD
• PAID CONSULTANT, ROYALTIES, INVESTOR UPEX
• PAID CONSULTANT DJO SURGICAL
• LOCKED PLATING: TREATMENT OPTION FOR PROXIMAL HUMERAL
FRACTURES
• IMPLANT COMPLICATIONS : SCREW CUTOUT
RELATIVELY COMMON
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AND VARUS
•
Locked Plating of the Proximal Humerus
Using an Endosteal Implant
Proximal Humeral Fracture Fixation:
Locking Plate Constuct +/- Intramedullary
fibular allograft
Hettrich, Neviaser, Beamer et al;
2012; 26(4); 212-215
Chow, Begum, Beaupre, Carey
2012 Jul;21(7):894-901
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• LOCKED LATERAL PLATING COMBINED WITH AN INTRAMEDULLARY
ALLOGRAFT FOR THE TREATMENT OF PROXIMAL HUMERUS
FRACTURES WOULD BE SIMILAR TO PUBLISHED STUDIES AND MITIGATE
VARUS COLLAPSE
• RETROSPECTIVE ANALYSIS OF ALL
2-,3- AND 4-PART FRACTURES
TREATED WITH LOCKED PLATING
AND INTRAMEDULLARY ALLOGRAFT
• 2PART—19(30%)
• 3PART—33(50%)
• 4PART—13(20%)
• MINIMUM ONE YEAR
CLINICAL F/U
• 65 PATIENTS
•
AVG AGE
68YRS
• XRAYS REVIEWED BY INDEPENDENT OBSERVER
• ASSOCIATIONS BETWEEN PATIENT AND FRACTURE SPECIFIC FACTORS
•
AGE
(>65 OR < 65YRS)
• FRACTURE TYPE (2, 3, OR 4-PART)
• HERTEL CRITERIA (>8MM OR <8MM MEDIAL HINGE)
• GENDER
• ASES SCORE
• SHOULDER ROM USING GONIOMETER.
• AVG F/U 22 MONTHS (RANGE: 12-53
• AVERAGE ASES SCORE: 79 (RANGE: 15-100)
• AVERAGE ROM
• FF: 125° (RANGE: 40°-180°)
• EXTERNAL ROTATION: 39° (RANGE: 0°-90°)
• HERTEL CRITERIA—MEDIAL HINGE
• 46 (71%) <8MM
• 19 (29%) >8MM
• MEAN HUMERAL NECK SHAFT ANGLE: 127° (RANGE, 104°-145°)
• 100% UNION
•
AVG TIME: 4.2M (RANGE: 1.5-8M)
• OVERALL COMPLICATION RATE: 18% (12/65)
• FRACTURE
MALUNION:
15% (10/65)
◦ 2 GREATER TUBEROSITY AVULSIONS
◦ 8 VARUS MALUNIONS (12%)
- 2 PATIENTS WITH VARUS MALUNIONS ALSO HAD SCREW PENETRATION
• SCREW PENETRATION: 6% (4/65)
• AVASCULAR
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NECROSIS:
3% (2/65)
• ALLOGRAFT STRUT HELPFUL AS REDUCTION AID AND INITIAL STABILITY IN SITUATIONS OF METAPHYSEAL
AND MEDIAL CALCAR COMMINUTION
• VARUS COLLAPSE WAS NOT DIMINISHED BY USE OF AN ALLOGRAFT STRUT
• UTILITY OF THIS TECHNIQUE IN “SOLVING” THIS PROBLEM IS QUESTIONED
• REVISION SURGERY HARDER
• AVOIDANCE OF THIS COMPLICATION IS LIKELY MULTIFACTORIAL RELATED TO TECHNICAL FACTORS
(MEDIAL SUPPORT, CALCAR SCREWS, ETC) AND PATIENT FACTORS (OSTEOPOROSIS, PATIENT
COMPLIANCE, ETC)