intramedullary plating of complex proximal humerus fractures: a case series

Objectives: to assess fracture union rates using novel intramedullary plate technique. post-operative humeral neck-shaft angles, patient range of motion and complication profile were secondary outcomes of interest.methods: single surgeon, retrospective case series of surgical technique at major trauma centre in scotland. a 2.0mm mini-fragment plate was secured to the humeral head to act as an intramedullary strut during fixation in complex proximal humerus fractures. fracture union and neck-shaft angle were assessed radiologically, whilst range of motion and complication profiles were assessed clinically.results: twelve patients were followed up for an average of 10 months post-operatively. all achieved bony union with a mean neck-shaft angle of 128°. mean range of motion values were 100° forward elevation, 83° abduction, 60° internal rotation and 37° external rotation. four patients required further surgical intervention- two for hardware prominence, one for adhesive capsulitis and one for subsequent rotator cuff failure. there were no cases of avascular necrosis or infection.conclusion: this novel technique addresses the established biomechanical propensity of proximal humerus fractures to fail in varus collapse and screw cut-out. this method provides an alternative to arthroplasty in the most severe proximal humerus fractures and is readily adopted via standard orthopaedic kit. level of evidence: iv