gms | German Medical Science

Objectives: This comparative study investigates if an apical humeral head subchondral pulling anchor tightened to an angular stable plate with inferiorly directed angular-stable screws can decrease the complication rate of anglestable plate fixation of Osteoporotic varus displaced proximal humeral humeral fractures.

Methods: This study is a comparison between two groups of a consecutive case series, prospectively collected, treated by a single surgeon.

The review of the patient files was approved by the institutional ethical comité. Inclusion criteria are a minimum age of 70 y, varus-displaced two- or three-part fractures of the proximal humerus (11A2 and 11B1.1 or lego type 1 and 7 ) treated with an angular-stable plate. The first group was treated with a common proximal humeral locking plate technique with rotator cuff tension reducing sutures.

The second group was treated with one or two humeral head apex subchondral anchor(s) tightened to a proximally molded locking plate with inferiorly directed angle locking screws. Intra-articular Penetration of the humeral head locking screws, recurrence of varus displacement and reoperation were statistically compared using the chi-squared test.

Results: The first group consisted of 12 cases, 10 females and 2 males. Mean age was 82.4 years. Mean follow-up was 5.5 months (3 m -11 m). There were 5 type 1 and 7 type 7 fractures with a mean preop varus angulation of 89.7 degrees. There were five cases of recurrence, three cases of screw penetration and three revision surgeries.

The second group consisted of 38 cases, 32 females and 6 males. Mean age was 78 years. Mean follow-up was 8 months (5 m - 18 m). There were 16 type 1 and 23 type 7 fractures with a mean preop varus angulation of 89.7 degrees. Mean postop angulation degree was 131.5 degrees.

There was one secondary screw penetration, five cases of recurrence and two revision surgeries.

The statistical analysis showed a significant difference in screw penetration (p=0,012), in recurrence (p=0,031) and revision rate (p=0,046).

Conclusions: This humeral head pushpull plate technique using apical subchondral anchors and inferiorly directed anglestable screws significantly decreases secondary screw penetration, secondary recurrence and reoperation rate in the treatment of osteoporotic varus displaced proximal humeral fractures.