title: Proximal humerus fractures treated by percutaneous locking plate internal fixation.
abstract: BACKGROUND
  There is no consensually accepted recommendation for optimum surgical treatment of unstable fractures of the proximal humerus.
  
  
  OBJECTIVE
  Locked and minimally-invasive plating is a promising treatment option.
  
  
  METHODS
  The aim of this prospective, multicentric study is to describe a recently introduced surgical technique for proximal humeral fractures and to evaluate the radiographic and clinical outcomes of this operation. Closed and minimally-invasive reduction is first performed. A proximal humerus specific locking plate featuring multiple-angle screws is secondly implanted. Proper identification and protection of the axillary nerve with the index finger during plate insertion on the lateral humeral side is highly advisable. If it can't be palpated, a classic delto-pectoral approach should be preferred. Thirty-four patients were included in this study with a 1-year minimal postoperative follow-up. Twenty-two patients presented a two-part surgical neck fracture according to the Neer classification and 12 patients had a three-part valgus-impacted fracture. DASH (Disabilities of the Arm, Shoulder and Hand) and Constant scoring systems were used for functional evaluation.
  
  
  RESULTS
  Specifically, no axillary nerve injury and no loss of reduction were observed. The median Constant score and the mean DASH score were 82 and 26 respectively at 1-year follow-up. The age-adjusted functional scores values were satisfactory. Two of the patients (6%) required surgical revision for intra-articular screw penetration.
  
  
  CONCLUSIONS
  Our study suggests that percutaneous plating with angular screw fixation of proximal humeral fractures is a safe and effective method, which produces good functional and radiologic outcomes. These minimally-invasive techniques allowing a better preservation of soft-tissues help promote early functional recovery. This more friendly approach combined to upgraded implants and instruments will also improve early and long-term outcomes of these fractures.
authors.affiliation: Sacré-Coeur hospital of Montreal, 5400, boulevard Gouin-Ouest, Montreal, Quebec, Canada.
authors.forename: D-M
authors.initials: DM
authors.lastname: Rouleau
authors.forename: G-Y
authors.initials: GY
authors.lastname: Laflamme
authors.forename: G K
authors.initials: GK
authors.lastname: Berry
authors.forename: E J
authors.initials: EJ
authors.lastname: Harvey
authors.forename: J
authors.initials: J
authors.lastname: Delisle
authors.forename: J
authors.initials: J
authors.lastname: Girard
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012720:Severity of Illness Index; D012784:Shoulder Fractures / Q000473:pathology / Q000601:surgery*