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.
Subject(s)
Humans , Fracture Healing , Humerus , Methods , Postoperative Complications , Range of Motion, Articular , ShoulderABSTRACT
Objective To compare biomechanical properties of the helical and straight long PHILOS (proximal humerus internal locking system) plates (Synthes Inc., Switzerland), so as to provide some biomechanical evidence for treating proximal metaphyseal-diaphyseal humeral shaft fractures in clinic. Methods Twelve Synbone artificial bones of right humerus (SYNBONE Inc., Switzerland) were divided into two groups. In control group (n=6), the humerus was fixed with the 10 hole long straight PHILOS plate, while in experimental group (n=6), the humerus was fixed with the same long PHILOS plate which was precontoured for moulding (i.e. helical PHILOS plate). After the proximal metaphyseal-diaphyseal humeral shaft fractures were made in all artificial bones, the biomechanical properties of the specimens in two groups under 6 loading modes (i.e., axial tension and compression, torsion in the same and reverse direction, medial-lateral and anterior-posterior three-point bending) were tested en bloc and compared. ResultsCompare with control group, under 100-500 N tensile and compressive loads, the axial displacement at the fractured end in experimental group increased by about 95% and 58%, respectively. Under 0.6-3 N•m torsional moment in reversed direction, the tensional angle in experimental group was obviously smaller than that in control group, with a decrease of 55%-64%. Under medial-lateral bending moment of 1.5 and 3 N•m, no significant difference was found in deflection of the experiment and control group, while under medial-lateral bending moment of 4.5, 6 and 7.5 N•m, the deflection in experimental group decreased by 20%-30% as compared to control group. Under 0.6-3 N•m torsional moment in the same direction and 1.5-7.5 N•m anterior-posterior bending moment, both the torsional angle and the deflection in experimental group were larger than those in control group, with a significant difference (P＜0.05). Compared with control group, the tensile stiffness and compressive stiffness decreased by 49% and 36%, the torsional stiffness in the same direction decreased by 19% and that in reversed direction increased by 150%, three-point bending stiffness in medial lateral direction increased by 18% and that in anterior posterior direction decreased by 70% in experimental group, all with a significant difference (P＜0.05). ConclusionsCompared with the long straight PHILO plate, the long helical PHILOS plate has better biomechanical properties, which can meet the clinical need of proximal metaphyseal-diaphyseal humeral shaft fracture fixation and postoperative rehabilitation. This surgical technique is expected to be widely applied in clinic, especially with the advantage of minimal invasive surgery.
ABSTRACT
Objective To explore the fixation method of tibial helical plate for treatment of proximal and middle one-third of humeral fractures and evaluate the clinical outcome. Methods A review was performed on 15 patients with proximal and middle one-third of humeral fractures treated by tibial helical plate from May 2004 to February 2009. There were 10 males and five females, at age range of 19-65 years ( average 38.0 years). The surgical method was summarized and the shoulder function evaluated.Results The follow-up lasted for 7-24 months (mean 13 months) , which showed bony union in all patients, with mean union time of 4.7 months. There was no implant loosening or failure. According to Neer 's criteria, the result was excellent in seven patients and good in six, with excellence rate of 86.7%.Conclusions Open reduction and internal fixation using tibial helical plate is simple and effective for treatment of proximal and middle one-third of humeral fractures.