Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports

Sam-Guk Park

doi:10.12671/jkfs.2016.29.1.61

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Park: Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports

Case Report

Journal of the Korean Fracture Society 2016; 29(1): 61-67.

Published online: 19 January 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.1.61

Medial and Lateral Dual Plate Fixation for Osteoporotic Proximal Humerus Comminuted Fracture: 2 Case Reports

Sam-Guk Park, M.D.

Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.

Address reprint requests to: Sam-Guk Park, M.D. Department of Orthopaedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3640, Fax: 82-53-628-4020, 70radiorth@naver.com

Received 27 October 2015 Revised 23 November 2015 Accepted 23 November 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Some proximal humeral fractures in elderly patients are accompanied by medial metaphyseal comminution and quality of the bone is so poor that head preserving osteosynthesis seems to be amenable. In cases of medial metaphyseal comminution, lateral locking compression plate (LCP) fixation also has a tendency to become a matter of screw cut out or loss of fixation. The author reports on successful treatment of two osteoporotic proximal humeral fractures combined with medial meta-physeal comminution, with application of additional direct medial supporting plate fixation. Medial plate fixations were added when the fractures were still unstable after the conventional lateral LCP fixation and anterior circumflex humeral arteries had been ruptured before. The fixations were stable enough to start exercise immediately after surgery. The inclinations of the humeral neck were not changed until the last follow-up and clinical results were satisfactory without humeral head osteonecrosis which was a concern.

Keywords: Proximal humerus, Fracture, Osteoporosis, Osteonecrosis, Dual plate fixation

Figures and Tables

Fig. 1

(A) Preoperative anteroposterior radiograph suggested 3 part humerus surgical neck fracture according to Neer classification. (B) Immediate postoperative anteroposterior radiograph showing satisfactory fracture alignment with medial & lateral plate fixation. (C) Radiograph taken 50 weeks postoperatively showing no noticeable neck-shaft angle change in comparison with immediate postoperative plain radiograph and healing.

Fig. 2

(A, B) Three dimensional computed tomography image showing comminuted fracture at great tubercle, lesser tubercle and medial metaphysis. (C) Two dimensional computed tomography image suggested the length of the metaphyseal head extension was 12 mm and integrity of medial hinge was disrupted.

Fig. 3

Photographs of the patient taken 3 years postoperatively showing abduction of right shoulder joint to 180 degrees and forward flexion to 140 degrees, the same as her left shoulder.

Fig. 4

(A) Preoperative anteroposterior plain radiograph showing the proximal humeral comminuted fracture (Neer type 3) with shoulder joint dislocation. (B) Immediate postoperative plain radiograph showing satisfactory fracture alignment with medial & lateral plate fixation and reduced shoulder joint. (C) Radiograph taken 54 weeks postoperatively showing no noticeable neckshaft angle change in comparison with immediate postoperative plain radiograph and healing.

Fig. 5

Photographs taken during the surgery. (A) Humerus head was dislocated anteriorly and metaphysis was severely comminuted with bone defect. (B) Unstable varus malalignment state after lateral locking compression plate fixation. (C) Stable acceptable alignment after additional medial buttressing plate fixation.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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