My Locking Plates are the Answ er! Don’t Think Tw ice! Michael D. McKee, MD, FRCS(C) • Professor and Chair, Department of Orthopaedic Surgery • University of Arizona, College of Medicine, Phoenix, AZ •
• 78 yr old female, retired • Lives by self, stable medical conditions
• 10 weeks post injury • 130 degrees flexion • Minimal pain, functional, independant
Randomized Controlled Trial • Gracitelli M et. al. • “Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial” JSES 2016 • 72 patients, mean CS: 71 (plate) vs 70 (nail) • Re-operations, complications higher in nail group • “Fixation of PHFs with locking plates or locking IM nails produces similar clinical and radiologic results. Nevertheless, the complication and reoperation rates were higher in the nail group.”
How to Maximize Success w ith Proximal Humeral Lockimg Plates • 1. Calcar reduction • 2. No varus • 3. Calcar screw • 4. Suture / fix greater tuberosity
Calcar Reduction Calcar reduction
No Varus
No Varus Structural graft Compression -reduction
Technique
Calcar screw Calcar screw
Tuberosity / Cuff Rotator cuff fixed to shaft or plate
What problems do you have w ith the proximal humeral locking plate you currently use? • 1. Tuberosity fixation 54% • 2. Screw penetration into the joint 22% • 3. Loss of reduction / fixation 16% • 4. Difficulty of application 5% • 5. Other 3%
Tuberosity escape
Better tuberosity fixation
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