Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement

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Hengg C, Nijs S, Klopfer T, Jaeger M, Platz A, Pohlemann T, et al. Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial. Arch Orthop Trauma Surg. 2019;139(7):927–42. https://doi.org/10.1007/s00402-019-03142-6.

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• Foruria AM, Martinez-Catalan N, Valencia M, Morcillo D, Calvo E. Proximal humeral fracture locking plate fixation with anatomic reduction, and a short and cemented screws configuration, dramatically reduces the implant related failure rate in elderly patients. JSES International. 2021; In Press. https://doi.org/10.1016/j.jseint.2021.06.004. This study showed minimal fixation failure rates when locking plate fixation of proximal humeral fractures is performed following specific principles of fixation and a step-by-step surgical tecnique. It also suggested an association between valgus impaction fracture patterns and the development of global avascular necrosis in this population.

Goch AM, Christiano A, Konda SR, Leucht P, Egol KA. Operative repair of proximal humerus fractures in septuagenarians and octogenarians: does chronologic age matter? J Clin Orthop Trauma. 2017;8(1):50–3. https://doi.org/10.1016/j.jcot.2017.01.006.

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Miquel J, Martinez R, Santana F, Marimon P, Torrens C. Surgical treatment of proximal humeral fractures with the transosseous suture fixation. J Orthop Surg Res. 2021;16(1):405. https://doi.org/10.1186/s13018-021-02555-7.

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• Helfen T, Siebenburger G, Fleischhacker E, Gleich J, Bocker W, Ockert B. Operative treatment of 2-part surgical neck type fractures of the proximal humerus in the elderly: cement augmented locking plate PHILOS vs. proximal humerus nail multiloc(R). Injury. 2020;51(10):2245–52. https://doi.org/10.1016/j.injury.2020.06.026. This study did not find differences in outcome or complication rates after locking plate fixation vs third generation intramedullary nailing in patiens over 60-year-old. Both implants reached good outcomes with low complication rates if anatomic fracture reduction and accurate implant position was achieved.

Bai L, Fu ZG, Wang TB, Chen JH, Zhang PX, Zhang DY, et al. Radiological evaluation of reduction loss in unstable proximal humeral fractures treated with locking plates. Orthop Traumatol Surg Res. 2014;100(3):271–4. https://doi.org/10.1016/j.otsr.2013.12.024.

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• Varga P, Inzana JA, Fletcher JWA, Hofmann-Fliri L, Runer A, Sudkamp NP et al. Cement augmentation of calcar screws may provide the greatest reduction in predicted screw cut-out risk for proximal humerus plating based on validated parametric computational modelling: augmenting proximal humerus fracture plating. Bone Joint Res. 2020;9(9):534–42. https://doi.org/10.1302/2046-3758.99.BJR-2020-0053.R1. This study provides a computational model in which cement augmentation of calcar screws provides the strongest fixation. However, other clinical studies showed high rates of intra-articular cement leaking when these screws are augmented, so it results should be interpreted cautiously.

Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extrem. 2018;13(2):123–9. https://doi.org/10.1007/s11678-018-0440-x.

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