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Treatment of Proximal Humeral Fracture Using Polarus Nail and Philos Plate

  • Choi, Chang Hyuk (Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center) ;
  • Sim, Jung Hyun (Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center) ;
  • Lee, Sang Hwa (Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center) ;
  • Lee, Joo Hwan (Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center) ;
  • Nam, Jun Ho (Shoulder and Elbow Joint Service, Department of Orthopaedic Surgery, Daegu Catholic University Medical Center)
  • Received : 2014.06.22
  • Accepted : 2014.07.23
  • Published : 2014.09.30

Abstract

Background: To compare the treatment of the proximal humerus fracture using a Polarus nail or Philos plate, we aimed to analyze the functional recovery and the factors affecting the selection between the two types of surgery. Methods: The study included 107 patients with proximal humerus fracture who underwent surgery at our institution. Of these patients, 67 underwent surgery with Polarus nails (G1) and 40 with Philos plates (G2). In G1, the cases of two- and three-part fractures were 60 and 7 cases, in G2, the cases of two-, three-, and four-part fractures were 28, 10, and 2 cases, respectively. The average age was 61 years old, and the average follow-up period was 32.5 months. We compared radiological results, the functional recovery retrospectively. Results: The radiological union time was 6.8 weeks and 8.7 weeks on average in G1 and G2 (p < 0.05). At the one-year follow-up period, these were visual analogue scale (VAS) 1.355, forward flexion (FF) 130.968, external rotation (ER) 50.161, internal rotation (IR) L2 in G1, and VAS 0.781, FF 135.806 ER 51.25, IR L1 in G2, respectively, showing no significant differences between the two groups (p > 0.05). Similar observations were made at the final follow-up. In terms of functional recovery, no significant differences were seen at the one-year or at the final follow-up period (p > 0.05). Conclusions: For the surgical treatment of proximal humeral fracture, the selection of the type of surgery is affected by the fracture pattern. However, both methods give satisfactory outcomes and do not show significant differences in the functional outcome after the surgery.

Keywords

References

  1. Kannus P, Palvanen M, Niemi S, Parkkari J, Järvinen M, Vuori I. Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970-1998 and alarming projections for the new millennium. Acta Orthop Scand. 2000;71(5):465-70. https://doi.org/10.1080/000164700317381144
  2. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52(6):1090-103. https://doi.org/10.2106/00004623-197052060-00002
  3. Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011;93(1):1-11.
  4. Ko JY, Yamamoto R. Surgical treatment of complex fracture of the proximal humerus. Clin Orthop Relat Res. 1996;(327):225-37.
  5. Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg. 2008;17(1):42-54. https://doi.org/10.1016/j.jse.2007.03.016
  6. Cofield RH. Comminuted fractures of the proximal humerus. Clin Orthop Relat Res. 1988;(230):49-57.
  7. Louis UB. Fractures of the proximal humerus. In: Rockwood CA Jr, Masten FA III, eds. The shoulder. 1st ed. Philadelphia: W.B. Saunders Co; 1990. 287-334.
  8. Giannoudis PV, Xypnitos FN, Dimitriou R, Manidakis N, Hackney R. Internal fixation of proximal humeral fractures using the Polarus intramedullary nail: our institutional experience and review of the literature. J Orthop Surg Res. 2012;7:39. https://doi.org/10.1186/1749-799X-7-39
  9. Norouzi M, Naderi MN, Komasi MH, Sharifzadeh SR, Shahrezaei M, Eajazi A. Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures. Am J Orthop (Belle Mead NJ). 2012;41(5):E64-8.
  10. Kristiansen B, Christensen SW. Plate fixation of proximal humeral fractures. Acta Orthop Scand. 1986;57(4):320-3. https://doi.org/10.3109/17453678608994401
  11. Björkenheim JM, Pajarinen J, Savolainen V. Internal fixation of proximal humeral fractures with a locking compression plate: a retrospective evaluation of 72 patients followed for a minimum of 1 year. Acta Orthop Scand. 2004;75(6):741-5. https://doi.org/10.1080/00016470410004120
  12. Agel J, Jones CB, Sanzone AG, Camuso M, Henley MB. Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg. 2004;13(2):191-5. https://doi.org/10.1016/j.jse.2003.12.005
  13. Kim DW, Kim CK, Jung SW, Kim HS. Operative treatment of displaced proximal humerus fractures with the angular stable locking compression plate. Clin Shoulder Elb. 2011;14(1):27-34. https://doi.org/10.5397/CiSE.2011.14.1.027
  14. Rajasekhar C, Ray PS, Bhamra MS. Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg. 2001;10(1):7-10. https://doi.org/10.1067/mse.2001.109556
  15. Crolla RM, de Vries LS, Clevers GJ. Locked intramedullary nailing of humeral fractures. Injury. 1993;24(6):403-6. https://doi.org/10.1016/0020-1383(93)90106-G
  16. Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ. Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Relat Res. 1995;(313):200-5.
  17. Kim JH, Lee YS, Ahn TK, Choi JP. Comparison of radiologic and clinical results between locking compression plate and unlocked plate in proximal humerus fractures. J Korean Shoulder Elbow Soc. 2008;11(2):143-9. https://doi.org/10.5397/CiSE.2008.11.2.143
  18. Lekic N, Montero NM, Takemoto RC, Davidovitch RI, Egol KA. Treatment of two-part proximal humerus fractures: intramedullary nail compared to locked plating. HSS J. 2012;8(2):86-91. https://doi.org/10.1007/s11420-012-9274-z
  19. Konrad G, Audige L, Lambert S, Hertel R, Sudkamp NP. Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures. Clin Orthop Relat Res. 2012;470(2):602-9. https://doi.org/10.1007/s11999-011-2056-y
  20. Ponce BA, Thompson KJ, Raghava P, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg Am. 2013;95(16):e113(1-7). https://doi.org/10.2106/JBJS.K.00202