PERCUTANEOUS PLATING OF FRACTURES OF THE PROXIMAL HUMERUS: A PROSPECTIVE MULTI-CENTER CLINICAL TRIAL.

Although new locking plates allows for secure fixation of osteoporotic fractures in the proximal humerus, extensive soft tissue dissection is needed for their insertion. We report on a prospective clinical trial of the first thirty patients treated with plating of the proximal humerus though a minimally invasive percutaneous approach. All fractures healed within the first 6 months with no avascular necrosis or axillary nerve injury. At the latest follow-up, the median Constant score was sixty-eight and the mean DASH score was twenty-seven. This study suggests that percutaneous plating can be a safe and effective method of fixation. To evaluate the safety and efficacy of minimally invasive plating of the proximal humerus using validated disease-specific measures. Percutaneous insertion of a locking proximal humerus plate is safe and produces good early functional and radiologic outcomes. Plate fixation of the proximal humerus fractures may now be more desirable with the use of a biological approach by limiting surgical insult and allowing accelerated rehabilitation. All fractures healed within the first six months with no loss of correction. Two reoperations were needed to remove intra-articular screws placed too long. No infection or avascular necrosis were seen. At the lastest follow-up, the median Constant score was sixty-eight points, with an age ajusted score of seventy-six. The mean DASH score was twenty-seven points. Only age was independantly predictive of both the Constant and DASH functional scores. During a period of one year, thirty patients were operated with use of the LCP proximal humerus plate (Synthes) through a 3cm lateral deltoid splitting approach and a second 2 cm incision at the deltoid insertion. The axillary nerve was palped and easily protected during insertion. Only two-part (N=22) and three-part impacted valgus type (N=8) were included in this study since they can be reduced indirectly thru this percutaneous technique. The average follow-up was thirteen months (eight to twenty months). All patients had the Constant and DASH evaluations.