Elsevier

Injury

Volume 40, Issue 3, March 2009, Pages 240-244
Injury

Use of a “hybrid” locking plate for complex metaphyseal fractures and nonunions about the humerus

https://doi.org/10.1016/j.injury.2008.07.019Get rights and content

Abstract

Purpose

To review one surgeon's experience with a novel type of “hybrid” locking plate (which has both 3.5 mm and 4.5 mm locking holes) for difficult fractures of the meta-diaphyseal humeral shaft.

Methods

Over a 2-year period, 24 patients who presented with a metaphyseal humeral fracture or nonunion (proximal or distal) were treated surgically by a single surgeon. A “hybrid” locking plate containing 3.5 mm locking holes on one end and 4.5 mm locking holes on the other end (Metaphyseal plate, Synthes, Paoli, Pa) was used in all patients. The selection of this implant was based on fracture location and bone quality. Fractures were operated on through an anterolateral or direct posterior approach. All fractures were secured with a minimum of three 4.5 mm screws on one side of the fracture and three 3.5 mm screws on the other side. All patients were treated with a similar post-operative protocol for early range of shoulder and elbow motion.

Results

Three patients were lost to follow-up. The cohort consisted of 15 women and 6 men with a mean age of 49 years (range 18–78). There were 14 acute fractures and 7 nonunions. Twelve fractures involved the distal metaphyseal segment and 9 involved the proximal metaphyseal segment. Twenty-two patients completed a minimum 6-month clinical and radiographic follow-up and form the basis for this report. All 21 patients healed their fractures or nonunions at a mean of 4.5 months. There were no infections or hardware failures. In every case the “hybrid” nature of the plate design was felt to be advantageous.

Conclusion

This “second generation” metaphyseal locking plate, which affords the surgeon the ability to place a greater number of smaller calibre screws within a short bone segment, while using traditional large fragment screw fixation in the longer segment, is clearly an improvement in plate design. Meta-diaphyseal upper extremity long bones may serve as the most ideal location for this implant.

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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