Clin Orthop Surg.  2012 Sep;4(3):209-215. 10.4055/cios.2012.4.3.209.

Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

• Pawaskar A
• Lee KW
• Kim JM
• Park JW
• Aminata IW
• Jung HJ
• Chun JM
• Jeon IH

• KMID: 1392983
• DOI: http://doi.org/10.4055/cios.2012.4.3.209

Abstract

BACKGROUND
We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle.
METHODS
Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al.
RESULTS
The mean neck shaft angles were 133.6degrees (range, 100degrees to 116degrees) at immediate postoperative, 129.8degrees (range, 99degrees to 150degrees) at 3 months postoperative and 128.4degrees (range, 97degrees to 145degrees) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8degrees as compared to 1.3degrees in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant.
CONCLUSIONS
The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.

Keyword

Proximal humeral fracture; Neck shaft angle; Elderly population; Locking plate

MeSH Terms

Aged
Aged, 80 and over
Analysis of Variance
*Bone Plates
Female
Fracture Fixation, Internal/instrumentation/methods
Humans
Humerus/radiography/*surgery
Male
Shoulder Fractures/radiography/*surgery

Figure

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  Fig. 1 Measurement of neck shaft angle.

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  Fig. 2 Changes in the neck shaft (NS) angle over various time periods.

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  Fig. 3 Relation between patient age and the change in neck shaft angle (immediate postoperative minus last follow-up).

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  Fig. 4 Relation between fracture pattern and the change in neck shaft angle (immediate postoperative minus last follow-up).

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  Fig. 5 Relation between the combined cortical thickness (CCT) and the change in neck shaft angle (immediate postoperative minus last follow-up).

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