Top

Clinical Orthopaedics and Related Research®

Published in:

01-02-2012 | Clinical Research

Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

Authors: Gerhard Konrad, MD, Laurent Audigé, PhD, Simon Lambert, MD, Ralph Hertel, MD, Norbert P. Südkamp, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2012

Abstract

Background

There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures.

Questions/purposes

The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures.

Patients and Methods

Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12 months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts.

Results

Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12 months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative complications were directly related to the initial surgical procedure.

Conclusions

The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant.

Level of Evidence

Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Agudelo J, Schürmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma. 2007;21:676–681.PubMedCrossRef

Armitage P, Berry G, Matthews JNS. Statistical Methods in Medical Research. Ed 4. Oxford, UK: Blackwell Publishing; 2002.CrossRef

Blum J, Hansen M, Muller M, Rommens PM, Matuschka H, Olmeda A, Radziejowski MJ, Merbold W, Nijs S, Angeloni R. Proximal humerus fractures and intramedullary nailing: experience with a new nail system. Eur J Trauma Emerg Surg. 2009;5:489–498.CrossRef

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillman P, Kohut G, Ekelund A, Muller M, Audigé L, Babst R. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23:163–172.PubMedCrossRef

Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br. 2010; 92:535–539.PubMedCrossRef

Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, Marynissen H. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:205–210.PubMedCrossRef

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMed

Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72:365–371.PubMedCrossRef

Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. J Orthop Trauma. 2008;22:159–164.PubMedCrossRef

10.

Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res. 2005;430:176–181.PubMedCrossRef

11.

Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86:848–855.PubMedCrossRef

12.

Gradl G, Dietze A, Arndt D, Beck M, Gierer P, Borsch T, Mittlmeier T. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. Arch Orthop Trauma Surg. 2007;127:937–944.PubMedCrossRef

13.

Gradl G, Dietze A, Kaab M, Hopfenmuller W, Mittlmeier T. Is locking nailing of humeral head fractures superior to locking plate fixation? Clin Orthop Relat Res. 2009;467:2986–2993.PubMedCrossRef

14.

Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. 2010;(12):CD000434.

15.

Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand. 2000;71:465–470.PubMedCrossRef

16.

Kazakos K, Lyras DN, Galanis V, Verettas D, Psillakis I, Chatzipappas Ch, Xarchas K. Internal fixation of proximal humerus fractures using the Polarus intramedullary nail. Arch Orthop Trauma Surg. 2007;127:503–508.PubMedCrossRef

17.

Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate : presentation of 225 cases of dislocated fractures] [in German]. Unfallchirurg. 2006;109:1032–1040.PubMedCrossRef

18.

Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clin Orthop Relat Res. 2006;442:115–120.PubMedCrossRef

19.

Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand. 1986;57:320–323.PubMedCrossRef

20.

Lin J. Effectiveness of locked nailing for displaced three-part proximal humeral fractures. J Trauma. 2006;61:363–374.PubMedCrossRef

21.

Linhart W, Ueblacker P, Grossterlinden L, Kschowak P, Briem D, Janssen A, Hassunizadeh B, Schinke M, Windolf J, Rueger JM. Antegrade nailing of humeral head fractures with captured interlocking screws. J Orthop Trauma. 2007;21:285–294.PubMedCrossRef

22.

Matziolis D, Kaeaeb M, Zandi SS, Perka C, Greiner S. Surgical treatment of two-part fractures of the proximal humerus: comparison of fixed-angle plate osteosynthesis and Zifko nails. Injury. 2010 May 18. [Epub ahead of print].

23.

Micic ID, Kim KC, Shin DJ, Shin SJ, Kim PT, Park IH, Jeon IH. Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures. J Orthop Sci. 2009;14:596–601.PubMedCrossRef

24.

Neer CS. Displaced proximal humeral fractures: I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077–1089.PubMed

25.

Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am. 2008;90:233–240.PubMedCrossRef

26.

Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.PubMedCrossRef

27.

Schmal H, Klemt C, Sudkamp NP. [Evaluation of shoulder arthroplasty in treatment of four-fragment fractures of the proximal humerus] [in German]. Unfallchirurg. 2004;107:575–582.PubMedCrossRef

28.

Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009;91:1689–1697.PubMedCrossRef

29.

Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humerus fractures with use of the locking proximal humeral plate: results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009; 91:1320–1328.PubMedCrossRef

30.

Thalhammer G, Platzer P, Oberleitner G, Fialka C, Greitbauer M, Vecsei V. Angular stable fixation of proximal humeral fractures. J Trauma. 2009;66:204–210.PubMedCrossRef

31.

Vallier HA. Treatment of proximal humerus fractures. J Orthop Trauma. 2007;21:469–476.PubMedCrossRef

32.

Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002;84:1919–1925.PubMed

Title: Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures
Authors: Gerhard Konrad, MD
Laurent Audigé, PhD
Simon Lambert, MD
Ralph Hertel, MD
Norbert P. Südkamp, MD
Publication date: 01-02-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2056-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 2/2012

Papers Presented at the Annual Meetings of the Hip Society 2011: Editorial Comment

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

The John Charnley Award: An Accurate and Extremely Sensitive Method to Separate, Display, and Characterize Wear Debris Part 2: Metal and Ceramic Particles

A More Reliable Method to Assess Acetabular Component Position

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty