Plating in Proximal Humeral Fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Proximal humeral fractures are increasingly common, particularly in active elderly populations.
• Treatment challenges include avascular necrosis, non-union, malunion, stiffness, pain, and functional disability.
• Advancements in imaging, understanding of humeral head perfusion, and implant technology are influencing treatment strategies.

Purpose of the Study:

• To evaluate the effectiveness of angular stable plate osteosynthesis for proximal humeral fractures.
• To compare outcomes of angular stable plates with traditional methods, particularly regarding long-term morbidity.
• To assess the value of locked plates in reducing complications, especially in osteoporotic bone.

Main Methods:

• Review of recent clinical reports and historical series on proximal humeral fracture treatment.
• Analysis of fixation techniques using angular stable implants versus non-angular stable plates.
• Consideration of surgical approaches and postoperative mobilization protocols.

Main Results:

• Angular stable plates show promise for anatomic stabilization of complex fractures, potentially avoiding endoprosthetic replacement.
• These implants offer improved purchase in osteoporotic bone and may broaden indications for plate osteosynthesis.
• Despite promising initial results, elevated complication rates persist, particularly in elderly osteoporotic patients, with current evidence often having low levels of certainty.

Conclusions:

• Angular stable plate osteosynthesis represents an advancement in treating proximal humeral fractures, offering potential for improved outcomes.
• Further high-quality comparative studies are essential to definitively establish the long-term value and optimal indications for locked plates.
• Minimally invasive techniques and early mobilization are crucial for preventing complications like subdeltoidal adhesions.