J Korean Orthop Assoc.  2017 Jun;52(3):232-239. 10.4055/jkoa.2017.52.3.232.

Helical Plating for Fractures of the Proximal Humeral Shaft

• Byun YS
• Shin DJ
• Park YB
• Kim MG
• Gu TH
• Han JH

• KMID: 2384553
• DOI: http://doi.org/10.4055/jkoa.2017.52.3.232

Abstract

PURPOSE
To evaluate the effectiveness of internal fixation with a helical plate for displaced proximal humeral shaft fractures by analyzing the clinical outcomes of patients.
MATERIALS AND METHODS
Fourteen displaced fractures of the proximal humeral shaft were treated by open reduction and internal fixation (ORIF) or by minimally invasive plate osteosynthesis (MIPO) with the use of helical locking compression plates. We evaluated the adequacy of reduction, time-to-fracture healing, range of motion of the shoulder, and postoperative complications. The functional outcome of the shoulder was evaluated using a Constant-Murley shoulder score.
RESULTS
Anatomical reduction of the fracture was obtained in nine cases treated by ORIF, and anatomical alignment was obtained in five cases treated by MIPO. All fractures were healed in an average of 14.9 weeks. The active range of motion of the shoulder was fully recovered in five cases, and restricted in nine cases, at around 12 months after surgery. The mean Constant-Murley shoulder score was 87.4 points, at around 12 months after surgery. There were no major complications, such as neurovascular injury, infection, loss of fixation, and nonunion.
CONCLUSION
Helical locking compression plating for proximal humeral shaft fractures is a safe and effective surgical method in obtaining satisfactory fracture healing and functional outcome because it provides stable fixation and avoids complications related with lateral plating.

Keyword

humerus; proximal shaft fracture; helical plate

MeSH Terms

Fracture Healing
Humans
Humerus
Methods
Postoperative Complications
Range of Motion, Articular
Shoulder

Figure

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  Figure 1 (A) A locking plate, PHILOS is contoured in a helical shape using the model of the humeurs. (B) A PHILOS was contoured on a helical plate. (C) A metaphyseal locking compression plate was contoured in a helical plate.

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  Figure 2 Case 12. (A) Initial anteroposterior radiograph of a 55-year-old woman shows a displaced simple spiral fracture of the proximal humeral shaft. (B) Radiographs after open reduction and internal fixation show anatomical reduction of the fracture fixed with lag screws and a helical plate made with PHILOS. (C) Radiographs 14 weeks after surgery show good fracture healing. (D) Eighteen months after surgery the plate and screws were removed due to shoulder pain by subacomical impingement.

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  Figure 3 Case 2. (A) Initial anteroposterior radiograph of a 44-year-old woman shows a complex fracture of the proximal humeral shaft. (B) Radiographs after minimally invasive plate osteosynthesis show anatomical alignment of the fracture fixed with a helical plate made with metaphyseal locking compression plate. (C) Radiographs 16 weeks after surgery show good fracture healing with callus formation. (D) Radiographs three years after surgery show consolidation of the callus with remodeling.

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