The average time from injury to surgery was 6.6 days (range, 2–14 days). All fractures were closed without combined injuries to the same limb. All patients had an explicit history of trauma, including four cases of bicycle injuries, 10 cases of walking injuries, and one case of falling from height. The left arm was affected in four patients, and the right arm was affected in 11 patients. Six men and nine women were included in the study, the average age of the patients was 61.53 years (range, 32–76 years), and all of them were right-handers. Finally, 15 proximal humeral fractures with severe medial instability were reduced and fixed with the help of an anteromedial locking plate. The exclusion criteria were pathologic fractures, open fractures, fractures with neurovascular injury, fractures of > 2 weeks, and those combined with other fractures involving the ipsilateral upper limb. The inclusion criterion was the presence of comminuted metaphyseal proximal humeral fractures. All patients signed written informed consent forms, including the requirement for internal fixation, and the statement of double plates when necessary. From January 2018 to July 2020, 72 patients with operated proximal humeral fractures were admitted to our study. This research was approved by the Institutional Review Board of the authors’ affiliated institutions. The findings asserted that an anteromedial locking plate effectively improves the reduction quality and helps in reconstructing the medial hinge in proximal humeral fractures with medial instability. In this study, we have reported the radiological and functional outcomes of our novel technique for managing these fractures. Therefore, fractures with medial instability remain technically difficult to tackle. However, reconstruction of the medial hinge could only be achieved through indirect manipulations, considering the complexity of the neighboring structures. Furthermore, anatomical fracture reduction and correct alignment of the medial cortices are the two most important prognostic factors in terms of secondary displacement, and the disrupted medial hinge should be reconstructed prior to the application of additional reduction maneuvers. This is especially true for unstable and displaced proximal humeral fractures involving the anatomical neck or with disruption of the medial hinge. Īlthough various methods such as applying traction on the arm and suture, elevator, and joystick techniques have been proposed, the overall anatomical or acceptable fracture reduction remains low, which results in a high complication rate. The latter can provide anatomical reduction and stable fixation, allowing early functional exercise with improved function. Since conservative therapy is associated with several complications, surgical treatment of displaced proximal humeral fracture is advocated. However, recent studies have found that up to 64% of proximal humeral fractures are displaced. Neer has stated that most proximal humeral fractures with slight or no displacement could be treated conservatively. Proximal humeral fractures account for 4–5% of all fractures and predominantly occur in elderly patients. The use of an anteromedial small locking plate improved the reduction efficiency, reconstructed the medial support, and alleviated the occurrence of complications in proximal humeral fractures with medial instability. The mean Constant score was 79.8 (range, 68–92) during the final visit. Postoperative X-ray showed avascular necrosis and screw penetration in one patient, while screw penetration, varus malunion, or significant reduction loss was not found in the other cases. Complications such as infection and neurovascular injury were not observed. The average operation time was 108 min (range, 70–130 min), and the mean fracture union time in all patients was 12.13 weeks (range, 8–16 weeks). Subsequently, the radiological and clinical outcomes were evaluated over an average follow-up period of 18.53 months. Methodsįifteen cases of proximal humeral fractures with medial instability (five cases were classified as three-part and ten as four-part by Neer classification) were treated by the proposed reduction technique using an anteromedial small locking plate. Currently, the reduction and support of comminuted medial cortex of humeral fracture remains a challenge, Therefore, a novel reduction and fixation technique that employs an anteromedial small locking plate was explored in this study, and its viability and the associated complications were assessed.
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