Reviewing our institutional experience of percutaneous versus open plating of proximal humeral fractures

Abstract

Background: Fractures of the proximal humeral are a common referral to orthopaedic centres. While undisplaced fractures can be managed  conservatively with a plaster U-slab, the Neer criteria define the requirements for operative intervention. Pre-countoured titanium locking plates are  the mainstay of operative intervention in these patients however several studies report the advantages of percutaneous humeral plating in 2-part proximal humeral fractures.

Objectives: To compare the operative parameters, and post-operative outcome, of 23 patients who underwent open plating of their 2-part proximal humerus fractures, to those of 26 patients with the same fracture site and configuration, who underwent percutaneous plating.

Methods: We performed a retrospective chart review of 49 patients who presented to our unit with proximal 2-part humeral fractures over a 6-year period from the 1st January 2014 to 29th November 2019, 23 of which underwent open plating and 26 of which underwent percutaneous plating. The data captured and analysed in this study included patient’s age; gender; mechanism of injury; fracture pattern; indication for surgery; whether an open plating or minimally invasive percutaneous plating was performed; time from injury to operative intervention; length of operative  procedure; volume of intra-operative blood loss; complications; amount of early post-operative surgical site pain assessed by the Visual Analogue Pain Scale score; range of shoulder movement at the 3-week follow-up appointment; length of hospital stay; and patient satisfaction at a 1-year
follow-up end point.

Results: The findings were that when comparing open humeral plating versus percutaneous humeral plating, in the management of 2-part humeral fractures, a significant reduction was demonstrated in; length of surgery; volume of intra-operative blood loss; length of hospital stay; three-week functional recovery; one-year patient satisfaction, all of which favoured the percutaneous humeral plating group.

Conclusion: Percutaneous humeral plating offers significant advantages over open plating in 2-part proximal humeral fractures. We recommend that this should be the primary operative procedure considered by orthopaedic surgeons who manage this form of fracture configuration.

Key words: Percutaneous plating proximal 2-part humeral fractures, Open plating proximal 2-part humeral fractures