Unexpected high complication rate following internal fixation of unstable proximal humerus fractures with an angled blade plate.


OBJECTIVES:The increasing number of fractures of the proximal humerus, especially in the elderly, carries with it the unsolved problem of the optimal treatment for the displaced or unstable fractures. The authors' goal was to analyze whether fixation with a bent valgus angled blade plate could improve the outcomes reported in the literature to date. DESIGN:Prospective clinical study. SETTING:Urban level 1 university trauma center. PATIENTS:Over a 27-month period, 42 consecutive patients were treated for an unstable or displaced proximal humerus fracture. INTERVENTION:Open reduction and internal fixation with a 90-degree cannulated angled blade plate prebent to 110 degrees. MAIN OUTCOME MEASUREMENTS:Active follow-up for 1 year with assessment of objective and subjective functional results (ie, motion; strength; Constant score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and visual analog scale (VAS)) and radiographic assessment (reduction, alignment, necrosis, and nonunion). RESULTS:Follow-up was completed for 86% of the patients, who achieved a mean Constant score of 66 points (82% of the contralateral side) with a mean forward flexion of 125 degrees and an average strength of 72% of the contralateral side. Low disability (mean DASH score 22) and pain values (mean VAS 2) were demonstrated after this type of stabilization. The overall complication rate was 33% (12/36), with protrusion of the blade into the glenohumeral articulation as the most frequent problem (8/36, 22%). The negative impact of an adverse event on subjective and objective outcomes was only significant for forward flexion (P = 0.02). Neither clinical outcome nor complication rate was different when compared to patients with regard to fracture type (3 versus 4 parts) or age (younger or older than 70 years). CONCLUSIONS:Fixation of displaced proximal humeral fractures with an angled blade plate provided sufficient stability. Blade perforation into the humeral joint occurred in every fourth patient and was found to be the major reason for a high complication rate. In view of this major problem, the technique described here cannot be recommended, even though the absence of nonunions in our series seems to support the low invasiveness of this surgical approach.


J Orthop Trauma


Meier RA,Messmer P,Regazzoni P,Rothfischer W,Gross T




Has Abstract


2006-04-01 00:00:00














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    abstract::Posterior wall (PW) fractures are the most common fractures requiring surgical fixation in acetabular surgery. Extra-articular screw placement must be confirmed intraoperatively. Herein we describe the use of the inlet and obturator oblique view (the Leeds view) for screw placement in elementary PW and in associated b...

    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章


    authors: Tosounidis TH,Giannoudis PV

    更新日期:2017-04-01 00:00:00

  • Magnetic Resonance Imaging of Trauma Patients Treated With Contemporary External Fixation Devices: A Multicenter Case Series.

    abstract:OBJECTIVES:To report the safety and clinical outcomes of placing current magnetic resonance imaging (MRI) components inside and outside the MRI bore during MRIs. DESIGN:Retrospective case series. SETTING:Four trauma centers (3 Level I and 1 Level II), from January 2005 to January 2015. PATIENTS:All patients who had ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,多中心研究


    authors: Hayden BL,Theriault R,Bramlett K,Lucas R,McTague M,Bedi HS,Flacke S,Weaver MJ,Marcantonio AJ,Ryan SP

    更新日期:2017-11-01 00:00:00

  • Vertically Oriented Femoral Neck Fractures: A Biomechanical Comparison of 3 Fixation Constructs.

    abstract:OBJECTIVES:To compare the static and dynamic mechanical properties of a modified crossed cannulated screw (CS) configuration, the inverted triangle (IT) cannulated screw configuration, and a compression hip screw (CHS) with derotation screw in Pauwels type III femoral neck fractures. METHODS:Thirty synthetic femora we...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Johnson JP,Borenstein TR,Waryasz GR,Klinge SA,McClure PK,Chambers AB,Hayda RA,Born CT

    更新日期:2017-07-01 00:00:00

  • Intraoperative fluoroscopic evaluation of screw placement during pelvic and acetabular surgery.

    abstract::The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and ar...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审


    authors: Yi C,Burns S,Hak DJ

    更新日期:2014-01-01 00:00:00

  • CT scan assessment of the syndesmosis: a new reproducible method.

    abstract:OBJECTIVES:Anatomic reduction of the fibula with regard to the tibia is the goal when treating syndesmotic injuries. No objective method exists to describe the distal tibiofibular relationship. The primary and secondary objectives of this study was to describe and validate radiologic measurements of the syndesmosis and...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Nault ML,Hébert-Davies J,Laflamme GY,Leduc S

    更新日期:2013-11-01 00:00:00

  • Open reduction and plate fixation of displaced AO type C3 fractures of the distal radius: restoration of articular congruity in eighteen cases.

    abstract:OBJECTIVE:To determine the ability of open reduction and plate fixation to restore articular congruity in the treatment of fractures of the distal radius with intraarticular comminution and displacement. DESIGN:Prospectively followed series. METHODS:Eighteen consecutive fractures of the distal radius with intraarticu...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Schneeberger AG,Ip WY,Poon TL,Chow SP

    更新日期:2001-06-01 00:00:00

  • A method for detection of lateral malleolar malrotation using conventional fluoroscopy.

    abstract::Recent studies on ankle syndesmosis injuries have shown that a significant amount of rotational malediction of the distal fibula are missed and may lead to poor functional outcome. A new set of radiographic criteria were developed to help detect distal fibula internal and external rotation using conventional fluorosco...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Marmor M,Kandemir U,Matityahu A,Jergesen H,McClellan T,Morshed S

    更新日期:2013-12-01 00:00:00

  • Biomechanics of Ender rods, compression screw, and Zickel nail in the fixation of stable subtrochanteric femur osteotomies.

    abstract::Compression screws, Ender rods, and Zickel nails were evaluated mechanically to determine their resulting stability in the fixation of experimental subtrochanteric femur osteotomies. Twenty-five pairs of human cadaver femurs were used. Experimental osteotomies were created and a random member of each pair was fixed wi...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Wainer RA,Wright PH,Gilbert JA,Taylor DF

    更新日期:1990-01-01 00:00:00

  • Fluoroscopically guided hip capsulotomy: effective or not? A cadaveric study.

    abstract:OBJECTIVE:The purpose of this study was to examine the efficacy of a fluoroscopically guided hip capsulotomy. METHODS:Ten fresh-frozen paired cadaveric hips were injected under fluoroscopic guidance with saline sufficient to generate an intra-articular pressure greater than 58 mmHg. The pressure was monitored continuo...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Christal AA,Taitsman LA,Dunbar RP Jr,Krieg JC,Nork SE

    更新日期:2011-04-01 00:00:00

  • Preinjury Narcotic Use Does Not Affect Treatment for Compartment Syndrome.

    abstract:OBJECTIVES:To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma. DESIGN:Retrospective case-control study. SETTING:Level 1 trauma center. PATIENTS/PARTICIPANTS:We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower e...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Chen SR,Abblitt WP,Knoll OM,Cooper SA,Backstrom ZK,Jahangir AA,Sethi MK

    更新日期:2020-03-01 00:00:00

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Kummer FJ,Pearlman CA,Koval KJ,Ceder L

    更新日期:1997-04-01 00:00:00

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    abstract::A case of intracardiac malpositioning of a sternoclavicular Kirschner pin is reported. After an uneventful closed wire-fixation of sternoclavicular subluxation and a normal postanesthetic recovery, a 17-year-old male patient developed opacification of the right hemithorax and signs of internal bleeding. The lateral ch...

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    pub_type: 杂志文章


    authors: Smolle-Juettner FM,Hofer PH,Pinter H,Friehs G,Szyskowitz R

    更新日期:1992-01-01 00:00:00

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    abstract:BACKGROUND:Acceptable amounts of malrotation after CRPP for pediatric supracondylar humerus fracture (SCHFx) have yet to be defined. This is an attempt to correlate radiographic parameters of a malrotated SCHFx with degrees of rotational malalignment to assist intraoperative assessment of reduction. METHODS:3D models ...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Prabhakar P,Pierce WA,Standefer KD,Ho CA

    更新日期:2020-07-01 00:00:00

  • Uncemented Reverse Total Shoulder Arthroplasty as Initial Treatment for Comminuted Proximal Humerus Fractures.

    abstract:OBJECTIVES:To determine whether uncemented implants would provide similar outcomes while avoiding the complications associated with cement in the treatment of elderly patients with proximal humerus fractures (PHFs) with primary reverse total shoulder arthroplasty (RTSA). DESIGN:Case series. SETTING:A single Level I t...

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    authors: Wright JO,Ho A,Kalma J,Koueiter D,Esterle J,Marcantonio D,Wiater JM,Wiater B

    更新日期:2019-07-01 00:00:00

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Stahlman GC,Wyrsch RB,McNamara MJ

    更新日期:1995-01-01 00:00:00

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    abstract::The fracture classification systems currently used most frequently were not developed or validated by rigorous scientific evaluation methods. This paper discusses the classification of fractures from an epidemiological and clinical decision-making perspective and proposes a standardized methodological concept for thei...

    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审


    authors: Audigé L,Bhandari M,Hanson B,Kellam J

    更新日期:2005-07-01 00:00:00

  • The effect of suture pattern and tension on cutaneous blood flow as assessed by laser Doppler flowmetry in a pig model.

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    pub_type: 杂志文章


    authors: Sagi HC,Papp S,Dipasquale T

    更新日期:2008-03-01 00:00:00

  • An investigation of the contribution of the extraosseous tissues to the diaphyseal fracture callus using a rabbit tibial fracture model and in situ immunocytochemical localisation of osteocalcin.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Stafford H,Oni OO,Hay J,Gregg PJ

    更新日期:1992-01-01 00:00:00

  • Displaced intra-articular calcaneal fractures.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章,评审


    authors: Bajammal S,Tornetta P 3rd,Sanders D,Bhandari M

    更新日期:2005-05-01 00:00:00

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Matsushita T,Watanabe Y

    更新日期:2007-07-01 00:00:00

  • Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.

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    pub_type: 杂志文章


    authors: Streubel PN,Moustoukas MJ,Obremskey WT

    更新日期:2013-01-01 00:00:00

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    pub_type: 杂志文章


    authors: Braly HL,O'Connor DP,Brinker MR

    更新日期:2013-09-01 00:00:00

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Norris BL,Hahn DH,Bosse MJ,Kellam JF,Sims SH

    更新日期:1999-08-01 00:00:00

  • Biomechanical Assessment of Locking Plate Fixation of Comminuted Proximal Olecranon Fractures.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Fantry A,Sobel A,Capito N,Hodax JD,Pidgeon T,Koruprolu S,Rich R,Fava JL,Green A,Paxton S

    更新日期:2018-11-01 00:00:00

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Ryan SP,Tornetta P 3rd,Dielwart C,Kaye-Krall E

    更新日期:2011-12-01 00:00:00

  • International Survey: Factors Associated With Operative Treatment of Distal Radius Fractures and Implications for the American Academy of Orthopaedic Surgeons' Appropriate Use Criteria.

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    journal_title:Journal of orthopaedic trauma

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    authors: Kyriakedes JC,Crijns TJ,Teunis T,Ring D,Bafus BT,Science of Variation Group.

    更新日期:2019-10-01 00:00:00

  • No effect of low-intensity ultrasound on healing time of intramedullary fixed tibial fractures.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Emami A,Petrén-Mallmin M,Larsson S

    更新日期:1999-05-01 00:00:00

  • Volar dislocation of multiple carpometacarpal joints: report of four cases.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Kumar S,Arora A,Jain AK,Agarwal A

    更新日期:1998-09-01 00:00:00

  • Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Peindl RD,Zura RD,Vincent A,Coley ER,Bosse MJ,Sims SH

    更新日期:2004-09-01 00:00:00

  • A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats.

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    journal_title:Journal of orthopaedic trauma

    pub_type: 杂志文章


    authors: Bergenstock M,Min W,Simon AM,Sabatino C,O'Connor JP

    更新日期:2005-11-01 00:00:00