Osteosynthesis for proximal humeral fractures : Plating, double plating and more.

Sander KJ, Sußiek J, Wiethölter MJ, Raschke MJ, Katthagen JC

Abstract

Due to demographic changes, proximal humeral fractures (PHF) are becoming increasingly more frequent in routine clinical practice. At the same time, surgical treatment is more frequently indicated and more demanding due to increasingly more complex fracture morphology and declining bone quality. Osteosynthesis using locking plate fixation remains the mainstay of surgical treatment alongside reverse fracture arthroplasty. The treatment concept is individually dependent on the characteristics of the fracture morphology, the patient-specific risk profile and the expertise of the surgeon. In younger patients fracture fixation is preferable, when feasible. In recent years, combinations of different surgical techniques have been increasingly used to achieve humeral head preservation and sufficient stability. The risk of complications, such as secondary dislocation and screw cut-out has significantly decreased in recent years due to improved evaluation of the indications and surgical techniques. As one of these combined procedures, double plate fixation offers promising options for complex fractures due to an additional plate applied ventrally. This technique is increasingly becoming established in routine clinical practice. Cement augmentation of screws and different bone grafts are additional options to supplement locking plate osteosynthesis so that a good reconstruction result can also be achieved in osteoporotic bone.