Fri., 10/9/09 Upper Extremity, Paper #51, 11:57 am OTA-2009
A Comparison of Open versus Percutaneous Plating of Proximal Humerus Fractures
Jeffrey S. Staron, MD1 (n); B. Matthew Hicks, MD2 (n);
1Fort Wayne Medical Education Program,
2Fort Wayne Orthopaedics, Fort Wayne, Indiana, USA
Purpose: A number of interventions exist for the treatment of proximal humerus fractures. The various operative interventions can be viewed as more or less invasive when compared to each other. Each method has its own advantages and disadvantages. Because many of these fractures occur in patients with osteoporotic bone, locked plating has become a popular technique for fixation. The concept of preserving the soft-tissue envelope to aid in fracture healing has led to percutaneous plating techniques with these fixed-angle implants. The purpose of this study was to compare our outcomes of conventional open reduction and plating versus indirect reduction and percutaneous plating of 2- and 3- part proximal humerus fractures.
Methods: A retrospective chart review was performed of 2- or 3-part proximal humerus fractures repaired by a single orthopaedic traumatologist at one institution from 2002 to 2008. All patients were treated with the Synthes 3.5-mm LCP proximal humerus plate. Two cohorts of patients were identified. Conventional open reduction was performed through a deltopectoral approach between 2002 and 2007, and percutaneous plating technique was done through a less-invasive deltoid-splitting approach between 2006 and 2008. Comparisons were made between groups with respect to patient demographics, concomitant injuries, operative time and blood loss, complications, postoperative hospital stay, radiographic healing, functional outcome by use of DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and need for secondary interventions.
Results: Demographics were similar with regards to age, sex, body mass index, comorbidities, tobacco use, and nonsteroidal anti-inflammatory or steroid use. Average operative time for open treatment was 1.6 hours (range, 1.0-4.0) with average blood loss of 114 mL (range, 50-350), compared with 1.4 hours (range, 0.5-3.0) and 57 mL (range, 0-100) for those treated with the percutaneous method. No operative complications occurred in either group, including injury to the axillary nerve. The average hospital stay for both groups was 2.8 days. Time to radiographic healing for the open technique averaged 21.0 weeks (range, 9-52) versus 17.7 weeks (range, 10-34) for the percutaneous group. DASH questionnaire scores revealed a mean score of 41.0 (range, 24.2-62.1) in the open treatment group compared to 39.5 (range, 24.2-64.3) in the percutaneous plating group. Posteroperatively, 3 patients treated open and 4 patients treated by percutaneous method required a secondary intervention. The Mann-Whitney test was used for statistical analysis. A significant difference was found only with respect to operative blood loss.
Conclusion: Open reduction and internal fixation of displaced 2- and 3-part proximal humerus fractures can occur through open or minimally invasive techniques. Our retrospective cohort review found that during a single surgeon’s transition to a percutaneous technique, no increased intraoperative or postoperative complications were identified. Patient outcomes were maintained.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant