INTRODUCTION: Treatment of displaced proximal humerus fractures remains challenging. The introduction of locking plates has renewed interest in treating these fractures with joint-preserving techniques rather than hemiarthroplasty, but high complication rates are still reported. Avascular necrosis is not solely dependent on the initial fracture pattern, but can also result from intraoperative and postoperative vascular insults. METHOD: We describe a technique to minimize disruption of humeral head blood supply and maximize fracture fixation. A total of 34 patients with complex proximal humerus fractures were treated with a locking plate and endosteal implant through an anterolateral approach and followed for an average of 66 weeks to determine the rates of avascular necrosis. RESULTS: No patient suffered complete osteonecrosis (0%) and only one patient suffered partial necrosis (2.8%) of the humeral head. The length of the posteromedial hinge was not predictive of this complication. CONCLUSION: Use of the anterolateral approach and endosteal augment of a lateral locking plate can minimize avascular necrosis following proximal humerus fracture.
INTRODUCTION: Treatment of displaced proximal humerus fractures remains challenging. The introduction of locking plates has renewed interest in treating these fractures with joint-preserving techniques rather than hemiarthroplasty, but high complication rates are still reported. Avascular necrosis is not solely dependent on the initial fracture pattern, but can also result from intraoperative and postoperative vascular insults. METHOD: We describe a technique to minimize disruption of humeral head blood supply and maximize fracture fixation. A total of 34 patients with complex proximal humerus fractures were treated with a locking plate and endosteal implant through an anterolateral approach and followed for an average of 66 weeks to determine the rates of avascular necrosis. RESULTS: No patient suffered complete osteonecrosis (0%) and only one patient suffered partial necrosis (2.8%) of the humeral head. The length of the posteromedial hinge was not predictive of this complication. CONCLUSION: Use of the anterolateral approach and endosteal augment of a lateral locking plate can minimize avascular necrosis following proximal humerus fracture.
Authors: Stefan Quadlbauer; Georg J Hofmann; Martin Leixnering; Rudolf Rosenauer; Thomas Hausner; Jürgen Reichetseder Journal: Int Orthop Date: 2018-02-13 Impact factor: 3.075
Authors: Brian Skura; Matthew T Glazier; Hayden B Schuette; Braden J Passias; Iou-Ren Chang; John Verre; Sanjay Mehta; Benjamin C Taylor Journal: Cureus Date: 2022-03-16
Authors: Christoph J Laux; Florian Grubhofer; Clément M L Werner; Hans-Peter Simmen; Georg Osterhoff Journal: J Orthop Surg Res Date: 2017-09-25 Impact factor: 2.359