Evolution of fracture treatment with bone plates.

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Abstract

[Indexed for MEDLINE] 4. J Am Acad Orthop Surg. 2021 Jun 1;29(11):e523-e535. doi: 10.5435/JAAOS-D-20-00558. Principles of Locking Plate Fixation of Proximal Humerus Fractures. Omid R(1), Trasolini NA, Stone MA, Namdari S. Author information: (1)From the Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA (Omid), Midwest Orthopaedics at Rush, Chicago, IL (Trasolini), the Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Stone), and Rothman Orthopaedic Institute, Philadelphia, PA (Namdari). Proximal humerus fractures are common, particularly in elderly patients and those with osteopenia or osteoporosis. Although nonsurgical management results in satisfactory outcomes for most patients, surgical treatment is indicated in select cases. Despite an increasing trend toward arthroplasty, open reduction and internal fixation of proximal humerus fractures can still provide excellent clinical outcomes. Proper technique for internal fixation of the proximal humerus requires an understanding of osseous and neurovascular anatomy. In particular, understanding reliable regions of biomechanically superior bone can help prevent failure of fixation. Biomechanical studies have shown that locked plating of proximal humerus fractures provides stable fixation. Cadaveric and finite element models underscore the importance of screw placement in the posteromedial metaphysis. When medial column support is challenging to obtain, or when bone quality is poor, augmentation with bone autograft, allograft, and/or synthetic composites can improve the biomechanics of internal fixation constructs. The purpose of this review is to outline the anatomic, biologic, and biomechanical principles of plate fixation for proximal humerus fractures to provide evidence-based recommendations for optimizing fixation and preventing fixation failure. Copyright © 2021 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-20-00558