Proximal Humeral Fractures Plate or Nail ?

Yi Lu Ph.D., M.D.

Beijing Ji Shui Tan Hospital

NO DISCLOSURE

J Orthop Trauma 2006

Clinical Biomechanics. 2006

Oper orthop traumatol,2004

Personal experience：

FE = 148.9 ER = 29.3 IR = T9

ASES = 86.4 Constant = 87.5 UCLA = 30.2 SST = 9.6

2004.9 – 2007.9 92 / 111 pts F/U = 15m (12-36m)

Age = 48yrs（17－83） M/F = 37 / 55

Good/Excellent = 89.1%

• 12 papers，514 pts

• Age=62yrs,

• F/U=29.2m

• Union=96.6%

• FE=98 °AD=103 °

• DASH=26.6

Personal experience▪ 2005.3 — 2006.7 ▪ 2 part : 22 pts ▪ Age=57yrs(25-78) ▪ M/F=7/15 ▪ F/U=13m(6-24m)

All union FE=147.8°(100-180°), ER=45.5°(0-80°), IR=T10 level VAS:1.5(0-5) ASES:81.2(45-98.3) Constant:85.4(42-100) UCLA:29.9(16-35) SST:9.5(3-12)

E/G=81.8％

• 23pts： 3/4pats, Neer score post op: 89 & 60 -- Adedapo, Injury,2001

• 25 pts, 80% satisfied - Rajasekhar, JSES, 2001

• 14/15 non-union，14union，13 good -- Lin, Trauma, 2003

• To Nail or to Plate, it’s a problem …

No difference between nail / plate

Plate vs. Nail — Mechanic

“no significant differences in interfragmentary motion; but higher torsional load to failure and less torsional stiffness were found in plate group (P < 0.05).” -- Mayo Clinic 2010

Plate vs. Nail — Mechanic

Plate vs. Nail — Clinic

1y post op：plate > nail

3y post op：NO difference

-- Zhu & Lu JBJS (Am), 2011

ASES，VAS & strength

2 parts: Plate Vs. Nail

3 parts: Plate Vs. Nail

NO DIFFERENCE

Conclusion: If the medial hinge is preserved, we recommend locking plate fixation. In other cases, either technique can be used…

4 parts: Plate Vs. Nail

Case Age Classification Complication Cause1 35 4 impact values AVN initial injury2 59 4 impact values AVN initial injury3 27 4 parts AVN initial injury4 22 4 parts AVN initial injury5 28 3 GT + dislocation AVN initial injury6 39 2 LT + dislocation AVN initial injury7 33 2 surgical neck delayed union initial injury8 48 2 LT + dislocation arthritis initial injury9 29 2 surgical neck pneumothorax anesthesia

10 45 2 GT humeral shaft frcturea mal-practicing 11 29 3 GT screw penetration mal-practicing 12 40 2 surgical neck screw penetration mal-practicing 13 68 2 surgical neck screw penetration mal-practicing 14 72 2 surgical neck screw penetration mal-practicing 15 27 2 surgical neck HO mal-practicing 16 44 4 parts axillary v. injury mal-practicing 17 47 4 parts + dislocation screw loose unstable

most complications have no relation

wth plate itself !

Personal experience

both MIPPO… Minimal Invasive or Maximal Invasive?

post shoulder pain：20-41%

risk factors：

➢ age （negative）

➢ Ssp （positive）

how to treat Ssp in op Important ！！how to rehab Ssp post op

• poor function group：

• age > 72.5yrs

• medical status

• lower demand

• lower compliance

TAKE HOME MESSAGE

Thanks!

▪ ORIF for proximal humeral fractures: plate & nail

▪ Mechanical & Clinic: no difference!

▪ Each has it’s own complications