Use of a “hybrid” locking plate for complex metaphyseal fractures and nonunions about the humerus
Introduction
Anatomic location and bone quality are some of the factors that determine the complexity of fracture patterns. Proximal and distal humeral fractures and nonunions are examples of challenging injuries22 where the complex peri-articular anatomy, small fragment size of the bony segments involved, and the osteopenic quality of the metaphyseal bone make stable fixation difficult.15, 22, 23 Due to these anatomical difficulties, treating surgeons have sometimes been obliged to choose between treating fractures of the proximal and distal one-third of the humeral shaft with a smaller, “weaker” plate that allows more screws to be placed in the fracture segments, or a plate of larger diameter and greater implant strength with fewer screws in the short bony segments. Innovation in locking plate technology has improved our ability to treat fractures in osteoporotic bone and the development of “pre-contoured” or “anatomically correct” plate and screw designs has further advanced the ability to repair complex peri-articular fractures.
The purpose of this retrospective study was to report on the use of a “hybrid” locking compression plate that possesses different size locking holes at either end, for the treatment of complex proximal and distal humeral shaft fractures and nonunions by a single surgeon at a regional academic trauma centre. Our hypothesis was that treatment of difficult metaphyseal humeral shaft fractures with this novel implant would have higher union rates and lower complication rates than those previously reported for similar injuries treated with conventional locked plating.
Section snippets
Materials and methods
This was an IRB approved, retrospective chart review study. Between May 2006 and March 2008, a total of 67 patients with 57 acute fractures and 10 nonunions involving the humerus were treated by a single surgeon at our academic medical centre. Twenty-four of these patients with a proximal or distal metaphyseal humeral fracture or nonunion were treated surgically with a “hybrid” locking compression plate (Synthes LCP Metaphyseal plate, Synthes, Paoli, Pa) with 4.5 mm locking holes at one end and
Results
Twenty-four patients with 24 humeral fractures were treated with the metaphyseal locking plate over a 2-year period. Mechanism of injury was low velocity fall in 16, motor vehicle crash in 4, high velocity fall in 3 and gunshot wound in 2. One patient who died and two patients with incomplete follow-up were excluded. The 21 patients who constitute the basis of this report had a mean follow-up of 9.2 months (range 6–14 months) (Table 1). Fourteen acute fractures and seven nonunions were
Discussion
All patients in this cohort healed their fracture or fracture nonunion demonstrating satisfactory functional and radiographic results. There were no implant related complications and no small screw failures in this series. The metaphyseal locking plate seems to show promise for situations in which it may be advantageous to place a greater number of screws within a small segment of bone, such as certain difficult fractures of the meta-diaphyseal humeral shaft.
In their article discussing
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