My Locking Plates are the Answ er! Dont Think Tw ice! Michael D. - - PowerPoint PPT Presentation

My Locking Plates are the Answ er! Don’t Think Tw ice!

• Michael D. McKee, MD, FRCS(C)
• Professor and Chair, Department of Orthopaedic Surgery
• University of Arizona, College of Medicine, Phoenix, AZ

• 78 yr old female, retired
• Lives by self, stable medical conditions

• 10 weeks post injury
• 130 degrees flexion
• Minimal pain, functional, independant

Randomized Controlled Trial

• Gracitelli M et. al.
• “Locking intramedullary nails compared with

locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial” JSES 2016

• 72 patients, mean CS: 71 (plate) vs 70 (nail)
• Re-operations, complications higher in nail group
• “Fixation of PHFs with locking plates or locking IM

nails produces similar clinical and radiologic

• results. Nevertheless, the complication and

reoperation rates were higher in the nail group.”

How to Maximize Success w ith Proximal Humeral Lockimg Plates

• 1. Calcar reduction
• 2. No varus
• 3. Calcar screw
• 4. Suture / fix greater tuberosity

Calcar Reduction

Calcar reduction

No Varus

No Varus

Structural graft Compression -reduction

Technique

Calcar screw

Calcar screw

Tuberosity / Cuff

Rotator cuff fixed to shaft or plate

What problems do you have w ith the proximal humeral locking plate you currently use?

• 1. Tuberosity fixation 54%
• 2. Screw penetration into the joint 22%
• 3. Loss of reduction / fixation 16%
• 4. Difficulty of application 5%
• 5. Other 3%

Tuberosity escape

Better tuberosity fixation