Current concepts in locking plate fixation of proximal humerus fractures

Abstract

Despite numerous available treatment strategies, the management of complex proximal humeral fractures remains demanding. Impaired bone quality and considerable comorbidities pose special challenges in the growing aging population. Complications after operative treatment are frequent, in particular loss of reduction with varus malalignment and subsequent screw cutout. Locking plate fixation has become a standard in stabilizing these fractures, but surgical revision rates of up to 25% stagnate at high levels. Therefore, it seems of utmost importance to select the right treatment for the right patient. This article provides an overview of available classification systems, indications for operative treatment, important pathoanatomic principles, and latest surgical strategies in locking plate fixation. The importance of correct reduction of the medial cortices, the use of calcar screws, augmentation with bone cement, double-plate fixation, and auxiliary intramedullary bone graft stabilization are discussed in detail.

Keywords: Bone graft; Calcar screws; Cement augmentation; Locking plate fixation; Medial support; Proximal humeral fracture.

Fig. 1

Case of a 71-year-old female patient with a proximal humerus 3-part fracture with an impacted articular fragment (a, b). Due to the substantial metaphyseal loss of trabecular bone matrix, a fibula allograft (dashed outline) was used to support the locking plate fixation construct (c)