Locking Plate For Proximal Humeral Fractures

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Locking Plate For Proximal Humeral Fractures
Yi Lu MD, Ph.D
Shoulder Elbow service, Sports Medicine
Department Ji Shui Tan Hospital, 4th Clinical
Center, Peking University
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Disclosure

• not received any financial support or any
  commercial entity related to this presentation
• All production were approved by CDA FDA

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Traditional plate
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• anatomical fixation Internal fixator
  Angle stability

J Orthop Trauma 2006
Clinical Biomechanics. 2006
Oper Orthop Traumatol,2004
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Locking plate

• 2004.9 2007.9
• 92 / 111 pts
• F/U 15m ( 12 - 36 m )
• Age 47.7(17-83)
• Male 37,Female55
• 78 acute,14 delayed
• 46.7 of the dominant side

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Results

• FE 148.917.3 ER 29.315.0 IR T9 level
• The mean ASES 86.413.0
• Constant 87.510.6
• UCLA 30.24.0
• SST 9.6
• good or excellent 82 (89.1) fare 8 (8.7)
  poor 2 (2.2)

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Fresh/Delayed
P0.021
P0.036
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3 part GT Dislocation
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4 part delayed cases AVN 100
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Post op 21 month
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AP Axillary
Head-neck angle reverse angle GT/LT plate
screws
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v
?
Screw penetration
X
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but
3 month post op
6 month post op
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Why

• mulreduction
• osteoporosis
• locking plate itself

Gerber, JBJS-Br 2004 Hertal, Osteoporos Int
2005 Gardner,JOT 2007
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How to fix it ?
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!
Medial buttress function!
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• Perserve circulation
• Put the plate lateral to the bicep groove

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2 part LT dislocation Circulation was damaged
severely
10 month post op
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4 part valgus Impact 22.2
Is not equal to simple fracture
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15 late complications

• AVN
• Screw penetration
• Delayed union
• Arthritis
• Stress fracture
• HO

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Complication
P0.043
P0.032
P0.015
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Take Home Message

• Locking plate reliable method
• Early emergency
• Complications
• 4 part valgus impact 2 part LT dislocation!

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Thanks for your attention!