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Additional calcar support using a blade device reduces secondary varus displacement following reconstruction of the proximal humerus: a prospective study.

Beirer M, Crönlein M, Venjakob AJ, Saier T, Schmitt-Sody M, Huber-Wagner S, Biberthaler P, Kirchhoff C - Eur. J. Med. Res. (2015)

Bottom Line: There were no statistical significant differences in clinical outcome in all three groups.Group MA and group PA revealed significant secondary varus displacement in comparison to group PAB at the final follow-up compared to postoperative analysis (p < 0.001).The distance between the blade and the articular surface showed no significant increase in group PAB at the final follow-up compared to postoperative analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany. marc.beirer@mri.tum.de.

ABSTRACT

Background: Locking plate fixation of displaced fractures of the proximal humerus is still accompanied by a distinct complication rate, especially in case of osteoporotic bone, short-segment fracture length and comminution of the medial calcar. Secondary loss of reduction leading to varus deformity and screw cutout most frequently lead to surgical revision. The aim of the present study was to evaluate the clinical and radiological outcome of a recently developed polyaxial locking plate that allows for the additional placement of a helical blade device, aiming for support of the medial calcar.

Methods: In this prospective study, 17 patients with a mean age of 63.0 ± 16.0 years suffering from displaced fractures of the proximal humerus (Neer type two-, three- and four-part) were enrolled. All patients were surgically treated using a polyaxial locking plate with additional blade device (group PAB, n = 12) or without blade device (group PA, n = 5). Functional outcome was recorded using the Munich Shoulder Questionnaire allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), the Disability of the Arm, Shoulder and Hand (DASH score) and the Constant Score. Radiological outcome was assessed by analyzing standardized true anterior-posterior and outlet-view radiographs with respect to radiographic evidence of secondary varus displacement, cutout of screws and hardware failure. Results were compared to an age-, gender- and fracture type-matched collective treated by monoaxial locking plate fixation (group MA, n = 15).

Results: The mean follow-up was 12.4 ± 2.9 months after surgery. There were no statistical significant differences in clinical outcome in all three groups. Group MA and group PA revealed significant secondary varus displacement in comparison to group PAB at the final follow-up compared to postoperative analysis (p < 0.001). The distance between the blade and the articular surface showed no significant increase in group PAB at the final follow-up compared to postoperative analysis. Not-implant-related complications were seen in one and implant-related complications were seen in two patients in group PAB.

Conclusions: Polyaxial locking plate fixation with a blade device to restore medial cortical support reduces the risk of secondary varus displacement even in proximal humeral fractures of the elderly in comparison to monoaxial and polyaxial locking plate fixation without blade insertion.

No MeSH data available.


Related in: MedlinePlus

Tip-surface distances. a Proximal head screw; b medial head screw; c distal head screw; d blade device. *p < 0.05
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Fig7: Tip-surface distances. a Proximal head screw; b medial head screw; c distal head screw; d blade device. *p < 0.05

Mentions: In group PA the tip-surface distance of the proximal screw significantly increased whereas the tip-surface distance of the medial and distal screw row decreased during follow-up (Fig. 7). Interestingly, the contrary pattern was observed in group PAB. The tip-surface distance of the proximal screw slightly decreased, whereas the distance of the distal screw increased. However, this motion pattern turned out not to be statistically significant. The distance between the blade and the articular surface showed no significant change comparing the postoperative result and the final follow-up after 12 months (group PAB).Fig. 7


Additional calcar support using a blade device reduces secondary varus displacement following reconstruction of the proximal humerus: a prospective study.

Beirer M, Crönlein M, Venjakob AJ, Saier T, Schmitt-Sody M, Huber-Wagner S, Biberthaler P, Kirchhoff C - Eur. J. Med. Res. (2015)

Tip-surface distances. a Proximal head screw; b medial head screw; c distal head screw; d blade device. *p < 0.05
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597442&req=5

Fig7: Tip-surface distances. a Proximal head screw; b medial head screw; c distal head screw; d blade device. *p < 0.05
Mentions: In group PA the tip-surface distance of the proximal screw significantly increased whereas the tip-surface distance of the medial and distal screw row decreased during follow-up (Fig. 7). Interestingly, the contrary pattern was observed in group PAB. The tip-surface distance of the proximal screw slightly decreased, whereas the distance of the distal screw increased. However, this motion pattern turned out not to be statistically significant. The distance between the blade and the articular surface showed no significant change comparing the postoperative result and the final follow-up after 12 months (group PAB).Fig. 7

Bottom Line: There were no statistical significant differences in clinical outcome in all three groups.Group MA and group PA revealed significant secondary varus displacement in comparison to group PAB at the final follow-up compared to postoperative analysis (p < 0.001).The distance between the blade and the articular surface showed no significant increase in group PAB at the final follow-up compared to postoperative analysis.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675, Munich, Germany. marc.beirer@mri.tum.de.

ABSTRACT

Background: Locking plate fixation of displaced fractures of the proximal humerus is still accompanied by a distinct complication rate, especially in case of osteoporotic bone, short-segment fracture length and comminution of the medial calcar. Secondary loss of reduction leading to varus deformity and screw cutout most frequently lead to surgical revision. The aim of the present study was to evaluate the clinical and radiological outcome of a recently developed polyaxial locking plate that allows for the additional placement of a helical blade device, aiming for support of the medial calcar.

Methods: In this prospective study, 17 patients with a mean age of 63.0 ± 16.0 years suffering from displaced fractures of the proximal humerus (Neer type two-, three- and four-part) were enrolled. All patients were surgically treated using a polyaxial locking plate with additional blade device (group PAB, n = 12) or without blade device (group PA, n = 5). Functional outcome was recorded using the Munich Shoulder Questionnaire allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), the Disability of the Arm, Shoulder and Hand (DASH score) and the Constant Score. Radiological outcome was assessed by analyzing standardized true anterior-posterior and outlet-view radiographs with respect to radiographic evidence of secondary varus displacement, cutout of screws and hardware failure. Results were compared to an age-, gender- and fracture type-matched collective treated by monoaxial locking plate fixation (group MA, n = 15).

Results: The mean follow-up was 12.4 ± 2.9 months after surgery. There were no statistical significant differences in clinical outcome in all three groups. Group MA and group PA revealed significant secondary varus displacement in comparison to group PAB at the final follow-up compared to postoperative analysis (p < 0.001). The distance between the blade and the articular surface showed no significant increase in group PAB at the final follow-up compared to postoperative analysis. Not-implant-related complications were seen in one and implant-related complications were seen in two patients in group PAB.

Conclusions: Polyaxial locking plate fixation with a blade device to restore medial cortical support reduces the risk of secondary varus displacement even in proximal humeral fractures of the elderly in comparison to monoaxial and polyaxial locking plate fixation without blade insertion.

No MeSH data available.


Related in: MedlinePlus