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Published on: June 6, 2025
Retrospective analysis of proximal humeral fracture-dislocations managed with locked plates
Vivek Trikha1, Vivek Singh2, Buddhadeb Choudhury1
1Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Locked plates offer good functional outcomes for young adults with severe proximal humerus fracture-dislocations. This study shows successful fixation and union in most patients, with good range of motion and Constant scores.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Biomedical Engineering
Background:
- Proximal humerus fracture-dislocation is a severe injury common in young adults due to high-energy trauma.
- This study focuses on the outcomes of treating these complex injuries with locked plates.
Purpose of the Study:
- To evaluate the functional and radiologic outcomes of proximal humeral fracture-dislocations treated with locked plates.
- To assess the efficacy of locked plate fixation in young patients with high-energy trauma injuries.
Main Methods:
- Retrospective review of 33 proximal humeral fracture-dislocations in 29 patients (mean age 35 years).
- Treatment involved open reduction and internal fixation with locked plates between 2009 and 2013.
- 85% of injuries were high-energy, resulting in 3- or 4-part fracture-dislocations (27 anterior, 6 posterior).
Main Results:
- Average delay to surgery was 7 days, with a mean follow-up of 40 months.
- All fractures achieved union at an average of 15 weeks post-surgery.
- Mean final forward flexion was 129°, abduction 128°, and Constant score 78. Minor complications included two cases of osteonecrosis and two screw perforations.
Conclusions:
- Locked plate fixation is effective for young patients with 3- and 4-part proximal humeral fracture-dislocations.
- Good functional outcomes, including range of motion and stability, can be achieved.
- This treatment method demonstrates successful fracture healing and acceptable complication rates.
Background:
Fracture-dislocation is the extreme variant of injury to the proximal humerus that occurs more commonly in young adults as a result of high-velocity trauma. We evaluated the functional and radiologic outcome of fixation of proximal humeral fracture-dislocations with locked plates.
Methods:
This was a retrospective review of 33 proximal humeral fracture-dislocations in 29 patients with a mean age of 35 years (range, 19-60 years) treated by open reduction and internal fixation with locked plates between January 2009 and December 2013. The fracture-dislocation in 85% was the result of high-energy trauma resulting in 3- or 4-part fracture-dislocation. The fracture-dislocation was anterior in 27 and posterior in 6.
Results:
The average delay from injury to surgery was 7 days (range, 1-35 days), with a mean follow-up of 40 months (range, 24-66 months). All of the fractures united at an average of 15 weeks after surgery. At the final follow-up, the mean forward flexion was 129° (range, 100°-160°), and mean abduction was 128° (range, 100°-150°). The mean Constant score at the final follow-up was 78 points (range, 68-88 points). One case of complete osteonecrosis of the humeral head and 1 case of partial osteonecrosis of the humeral head were noted. Two cases of screw perforation of the humeral head were seen, with subsequent restricted range of motion improving after removal of the offending screws.
Conclusions:
Most young patients with 3- and 4-part proximal humeral fracture-dislocations can achieve good functional outcome after fixation with locked plates.
