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BMC Musculoskeletal Disorders

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Open Access 01-12-2020 | Research article

Assessment of the efficacy of the far cortical locking technique in proximal humeral fractures: a comparison with the conventional bi-cortical locking technique

Authors: Joong-Bae Seo, Jae-Sung Yoo, Yeon-Jun Kim, Kyu-Beom Kim

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

Locking plate fixation is one of the treatment strategies for the management of proximal humeral fractures. However, stiffness after locking plate fixation is a clinical concern. The mechanical stiffness of the standard locking plate system may suppress the interfragmentary motion necessary to promote secondary bone healing by callus formation. The far cortical locking (FCL) technique was developed to address this limitation in 2005. FCL increases construct flexibility and promotes callus formation. Our study aimed to evaluate the clinical and radiological outcomes of the FCL technique when implemented in proximal humeral fracture management. Furthermore, we compared the surgical outcomes of FCL with those of the conventional bicortical locking (BCL) screw fixation technique.

Methods

Forty-five consecutive patients who had undergone locking fixation for proximal humeral fractures were included in this study. A proximal humeral locking plate (PHILOS) system with BCL screw fixation was used in the first 27 cases, and the periarticular proximal humeral locking plate with FCL screw fixation was used in the final 18 consecutive cases. Functional capacity was assessed using the constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion. Radiographic outcomes were evaluated using the Paavolainen method of measuring the neck-shaft angle (NSA).

Results

No significant differences in clinical outcomes (ASES score, constant score, and range of motion) were found between the two groups. The union rate at 12 weeks was significantly higher in the FCL group (94.4%) than in the BCL group (66.7%, p = 0.006). No significant differences in NSA were found between the two treatment strategies. The complication rate was not significantly different between the two groups.

Conclusions

When implemented in proximal humeral fractures, the FCL technique showed satisfactory clinical and radiological outcomes as compared with the conventional BCL technique. The bone union rate at 12 weeks after surgery was significantly higher in the FCL group than in the BCL group. However, no significant difference in the final bone union rate was found between the two groups.

Karataglis D, Stavridis SI, Petsatodis G, Papadopoulos P, Christodoulou A. New trends in fixation of proximal humeral fractures: a review. Injury. 2011;42(4):330–8.CrossRefPubMed

Badman B, Frankle M, Keating C, Henderson L, Brooks J, Mighell M. Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff. J Shoulder Elb Surg. 2011;20(4):616–24.CrossRef

Esser RD. Open reduction and internal fixation of three- and four-part fractures of the proximal humerus. Clin Orthop Relat Res. 1994;299:244–51.

Hintermann B, Trouillier HH, Schafer D. Rigid internal fixation of fractures of the proximal humerus in older patients. J Bone Joint Surg Br. 2000;82(8):1107–12.CrossRefPubMed

Bottlang M, Doornink J, Lujan TJ, Fitzpatrick DC, Marsh JL, Augat P, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg Am. 2010;92(Suppl 2):12–22.CrossRefPubMedPubMedCentral

Gardner MJ, Nork SE, Huber P, Krieg JC. Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots. Injury. 2010;41(6):652–6.CrossRefPubMed

Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma. 2010;24(3):156–62.CrossRefPubMed

Bottlang M, Lesser M, Koerber J, Doornink J, von Rechenberg B, Augat P, et al. Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg Am. 2010;92(7):1652–60.CrossRefPubMedPubMedCentral

Kanakaris NK, Giannoudis PV. Locking plate systems and their inherent hitches. Injury. 2010;41(12):1213–9.CrossRefPubMed

10.

Bottlang M, Doornink J, Fitzpatrick DC, Madey SM. Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. J Bone Joint Surg Am. 2009;91(8):1985–94.CrossRefPubMedPubMedCentral

11.

Bottlang M, Feist F. Biomechanics of far cortical locking. J Orthop Trauma. 2011;25(Suppl 1):S21–8.CrossRefPubMedPubMedCentral

12.

Kidiyoor B, Kilaru P, Rachakonda KR, Joseph VM, Subramaniam GV, Sankineani SR, et al. Clinical outcomes in periarticular knee fractures with flexible fixation using far cortical locking screws in locking plate: a prospective study. Musculoskelet Surg. 2019;103(2):149–53.CrossRefPubMed

13.

Adams JD Jr, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics. 2015;38(3):e153–6.CrossRefPubMed

14.

Paavolainen P, Bjorkenheim JM, Slatis P, Paukku P. Operative treatment of severe proximal humeral fractures. Acta Orthop Scand. 1983;54(3):374–9.CrossRefPubMed

15.

Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br. 2001;83(6):799–804.CrossRefPubMed

16.

Hardeman F, Bollars P, Donnelly M, Bellemans J, Nijs S. Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury. 2012;43(2):153–8.CrossRefPubMed

17.

Lee SH, Dargent-Molina P, Breart G, Study EGEdlO. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res. 2002;17(5):817–25.CrossRefPubMed

18.

Stone MA, Namdari S. Surgical considerations in the treatment of osteoporotic proximal Humerus fractures. Orthop Clin North Am. 2019;50(2):223–31.CrossRefPubMed

19.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18(8):488–93.CrossRefPubMed

20.

Foruria AM, Carrascal MT, Revilla C, Munuera L, Sanchez-Sotelo J. Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: the role of implant stiffness. Clin Biomech (Bristol, Avon). 2010;25(4):307–11.CrossRef

21.

Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. 2010 mid-America Orthopaedic association physician in training award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res. 2011;469(6):1757–65.CrossRefPubMedPubMedCentral

22.

Henschel J, Tsai S, Fitzpatrick DC, Marsh JL, Madey SM, Bottlang M. Comparison of 4 methods for Dynamization of locking plates: differences in the amount and type of fracture motion. J Orthop Trauma. 2017;31(10):531–7.CrossRefPubMedPubMedCentral

23.

Bottlang M, Fitzpatrick DC, Sheerin D, Kubiak E, Gellman R, Vande Zandschulp C, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma. 2014;28(4):181–8.CrossRefPubMed

24.

Madey SM, Tsai S, Fitzpatrick DC, Earley K, Lutsch M, Bottlang M. Dynamic fixation of humeral shaft fractures using active locking plates: a prospective observational study. Iowa Orthop J. 2017;37:1–10.PubMedPubMedCentral

25.

Wang R, Zhang H, Cui H, Fan Z, Xu K, Liu P, et al. Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures. Injury. 2019;50(2):432–7.CrossRefPubMed

Title: Assessment of the efficacy of the far cortical locking technique in proximal humeral fractures: a comparison with the conventional bi-cortical locking technique
Authors: Joong-Bae Seo
Jae-Sung Yoo
Yeon-Jun Kim
Kyu-Beom Kim
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03821-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of the efficacy of the far cortical locking technique in proximal humeral fractures: a comparison with the conventional bi-cortical locking technique

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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