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