Similar Outcomes for Nail versus Plate Fixation of Three-part Proximal Humeral Fractures

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• 作者：Gerhard Konrad MD (1)
  Laurent Audigé PhD (2)
  Simon Lambert MD (3)
  Ralph Hertel MD (4)
  Norbert P. Südkamp MD (5)
  
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：470
• 期：2
• 页码：602-609
• 全文大小：325KB
• 参考文献：1. Agudelo J, Schürmann M, Stahel P, Helwig P, Morgan SJ, Zechel W, Bahrs C, Parekh A, Ziran B, Williams A, Smith W. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. / J Orthop Trauma. 2007;21:676-81. CrossRef
  2. Armitage P, Berry G, Matthews JNS. / Statistical Methods in Medical Research. Ed 4. Oxford, UK: Blackwell Publishing; 2002. CrossRef
  3. Blum J, Hansen M, Muller M, Rommens PM, Matuschka H, Olmeda A, Radziejowski MJ, Merbold W, Nijs S, Angeloni R. Proximal humerus fractures and intramedullary nailing: experience with a new nail system. / Eur J Trauma Emerg Surg. 2009;5:489-98. CrossRef
  4. Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillman P, Kohut G, Ekelund A, Muller M, Audigé L, Babst R. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. / J Orthop Trauma. 2009;23:163-72. CrossRef
  5. Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. / J Bone Joint Surg Br. 2010; 92:535-39. CrossRef
  6. Charalambous CP, Siddique I, Valluripalli K, Kovacevic M, Panose P, Srinivasan M, Marynissen H. Proximal humeral internal locking system (PHILOS) for the treatment of proximal humeral fractures. / Arch Orthop Trauma Surg. 2007;127:205-10. CrossRef
  7. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. / Clin Orthop Relat Res. 1987;214:160-64.
  8. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. / Acta Orthop Scand. 2001;72:365-71. CrossRef
  9. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates. / J Orthop Trauma. 2008;22:159-64. CrossRef
  10. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unstable fractures of the proximal humerus. / Clin Orthop Relat Res. 2005;430:176-81. CrossRef
  11. Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. / J Bone Joint Surg Br. 2004;86:848-55. CrossRef
  12. Gradl G, Dietze A, Arndt D, Beck M, Gierer P, Borsch T, Mittlmeier T. Angular and sliding stable antegrade nailing (Targon PH) for the treatment of proximal humeral fractures. / Arch Orthop Trauma Surg. 2007;127:937-44. CrossRef
  13. Gradl G, Dietze A, Kaab M, Hopfenmuller W, Mittlmeier T. Is locking nailing of humeral head fractures superior to locking plate fixation? / Clin Orthop Relat Res. 2009;467:2986-993. CrossRef
  14. Handoll HH, Ollivere BJ. Interventions for treating proximal humeral fractures in adults. / Cochrane Database Syst Rev. 2010;(12):CD000434.
  15. Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-998 and alarming projections for the new millennium. / Acta Orthop Scand. 2000;71:465-70. CrossRef
  16. Kazakos K, Lyras DN, Galanis V, Verettas D, Psillakis I, Chatzipappas Ch, Xarchas K. Internal fixation of proximal humerus fractures using the Polarus intramedullary nail. / Arch Orthop Trauma Surg. 2007;127:503-08. CrossRef
  17. Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W. [Treatment of proximal humeral fractures with the PHILOS angular stable plate : presentation of 225 cases of dislocated fractures] [in German]. / Unfallchirurg. 2006;109:1032-040. CrossRef
  18. Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the PHILOS plate: early experience. / Clin Orthop Relat Res. 2006;442:115-20. CrossRef
  19. Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. / Acta Orthop Scand. 1986;57:320-23. CrossRef
  20. Lin J. Effectiveness of locked nailing for displaced three-part proximal humeral fractures. / J Trauma. 2006;61:363-74. CrossRef
  21. Linhart W, Ueblacker P, Grossterlinden L, Kschowak P, Briem D, Janssen A, Hassunizadeh B, Schinke M, Windolf J, Rueger JM. Antegrade nailing of humeral head fractures with captured interlocking screws. / J Orthop Trauma. 2007;21:285-94. CrossRef
  22. Matziolis D, Kaeaeb M, Zandi SS, Perka C, Greiner S. Surgical treatment of two-part fractures of the proximal humerus: comparison of fixed-angle plate osteosynthesis and Zifko nails. / Injury. 2010 May 18. [Epub ahead of print].
  23. Micic ID, Kim KC, Shin DJ, Shin SJ, Kim PT, Park IH, Jeon IH. Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures. / J Orthop Sci. 2009;14:596-01. CrossRef
  24. Neer CS. Displaced proximal humeral fractures: I. Classification and evaluation. / J Bone Joint Surg Am. 1970;52:1077-089.
  25. Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. / J Bone Joint Surg Am. 2008;90:233-40. CrossRef
  26. Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. / J Bone Joint Surg Br. 1997;79:295-00. CrossRef
  27. Schmal H, Klemt C, Sudkamp NP. [Evaluation of shoulder arthroplasty in treatment of four-fragment fractures of the proximal humerus] [in German]. / Unfallchirurg. 2004;107:575-82. CrossRef
  28. Solberg BD, Moon CN, Franco DP, Paiement GD. Surgical treatment of three and four-part proximal humeral fractures. / J Bone Joint Surg Am. 2009;91:1689-697. CrossRef
  29. Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, K??b M, Luo C, Plecko M, Wendt K, K?stler W, Konrad G. Open reduction and internal fixation of proximal humerus fractures with use of the locking proximal humeral plate: results of a prospective, multicenter, observational study. / J Bone Joint Surg Am. 2009; 91:1320-328. CrossRef
  30. Thalhammer G, Platzer P, Oberleitner G, Fialka C, Greitbauer M, Vecsei V. Angular stable fixation of proximal humeral fractures. / J Trauma. 2009;66:204-10. CrossRef
  31. Vallier HA. Treatment of proximal humerus fractures. / J Orthop Trauma. 2007;21:469-76. CrossRef
  32. Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK. Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. / J Bone Joint Surg Am. 2002;84:1919-925.
  
• 作者单位：Gerhard Konrad MD (1)
  Laurent Audigé PhD (2)
  Simon Lambert MD (3)
  Ralph Hertel MD (4)
  Norbert P. Südkamp MD (5)
  
  1. Orthopaedic and Trauma Surgery, KKH Erding, Bajuwarenstr. 5, 85435, Erding, Germany
  2. AO Clinical Investigation and Documentation, Dübendorf, Switzerland
  3. Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Great Britain, UK
  4. Clinic for Orthopaedic Surgery, Lindenhofspital Bern, Bern, Switzerland
  5. Department of Orthopaedic and Trauma Surgery, Albert-Ludwigs-University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
  

文摘

Background There is a lack of consensus regarding optimal surgical management of displaced and unstable three-part proximal humeral fractures. Questions/purposes The objective of this prospective observational study was to compare the clinical and radiologic outcomes of plate versus nail fixation of three-part proximal humeral fractures. Patients and Methods Two hundred eleven patients with unstable three-part proximal humeral fractures were treated with ORIF using plate (PHILOS [proximal humeral interlocking system]/LPHP [locking proximal humerus plate]) or nail (PHN [proximal humeral nail]) osteosynthesis. Outcome measurements included pain, Constant and Murley and Neer scores, and the occurrence of complications at 3, 6, and 12?months postsurgery. Regression analysis and the likelihood ratio test were used to evaluate differences between the cohorts. Results Throughout the 1-year followup period the Constant and Murley scores improved significantly for both cohorts; there was no significant difference between the nail group compared with the plate group. Also, 1-year Neer scores were similar between the two cohorts. Patients in the PHN group perceived significantly less pain compared with patients in the plate fixation group at 3, 6 and 12?months after surgery. We observed 79 local complications in 60 patients with no significant risk difference between the treatment groups; 35 intraoperative?complications were directly related to the initial surgical procedure. Conclusions The similar 1-year outcomes for nail versus plate fixation of three-part proximal humeral fractures suggest that both techniques may be useful for internal fixation of these fractures. Many complications were related to incorrect surgical technique and therefore can be avoided. Advanced surgical skills and experience are considered to be more critical for successful operative treatment of three-part proximal humeral fractures than the selection of the implant. Level of Evidence Level II, therapeutic study (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.