Clin Orthop Surg.  2012 Dec;4(4):321-324. 10.4055/cios.2012.4.4.321.

Fixation Strategies to Prevent Screw Cut-Out and Malreduction in Proximal Humeral Fracture Fixation

• Namdari S
• Lipman AJ
• Ricchetti
• Tjoumakaris FP
• Huffman GR
• Mehta S

• KMID: 1719301
• DOI: http://doi.org/10.4055/cios.2012.4.4.321

Abstract

Fixation of proximal humerus fractures with precontoured, fixed angle devices has improved operative management of these difficult injuries, particularly in patients with osteoporosis. However, recent data has revealed that fixation with these constructs is not without complications, particularly screw cut-out and loss of reduction. Multiple strategies have been developed to decrease the number of complications. We offer a surgical technique combining suture augmentation of the proximal humerus with locked plate fixation utilizing short screws.

Keyword

Proximal humerus; Locking plate; Screw cut-out

MeSH Terms

Bone Plates
Bone Screws
Fracture Fixation/*instrumentation/*methods
Humans
Shoulder Fractures/rehabilitation/*surgery

Figure

• 

  Fig. 1 Delto-pectoral exposure revealing the long head of the biceps brachii, which is released from the supraglenoid tubercle. Stay sutures are placed in the supraspinatus, infraspinatus, and subscapularis tendons to aid in fracture reduction. The fracture is exposed well lateral to the bicipital groove. The deltoid and pectoralis tendon insertions may be left completely intact, even in long fractures extending into the humeral shaft.

• 

  Fig. 2 A short, locking precontoured plate is prepared, and sutures are placed through the eyelets of the plate (3.5-mm locking compression plate Proximl Humerus Plate, Synthes Inc.) superiorly (supraspinatus tendon), anteriorly (subscapularis), and posteriorly (infraspinatus).

• 

  Fig. 3 The plate is initially secured to the humeral shaft with a non-locked, bicortical screw through the diaphyseal portion of the plate. Sutures through the rotator cuff and through the plate are shown. The plate is positioned lateral to the bicipital groove.

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