title: Treatment for proximal humeral fractures with percutaneous plating: our first results.
abstract: BACKGROUND
  Proximal humeral fractures are common lesions; there is no generally accepted strategy about the treatment for displaced and unstable two- to four-part fractures. We have nowadays many different surgical solutions, ranging from percutaneous pinning to shoulder arthroplasty. Percutaneous plating can be a good solution to treat some of these fractures using a minimally invasive technique and performing stable fixation that can allow early mobilization. Purpose of this paper is to evaluate the results of our first cases of percutaneous plating in proximal humeral fractures in order to assess the theoretical advantages and the incidence of possible complications.
  
  
  METHODS
  From June 2009 to February 2012, we treated 29 proximal humeral fractures with a percutaneous plating (NCB-PH plate) through an anterolateral deltoid split. For each patient, we evaluated the clinical outcome according to Constant score and the radiographic results, paying attention to fracture healing, loss of reduction, hardware complications, and head necrosis.
  
  
  RESULTS
  The clinical evaluation gave a mean Constant score value of 79 points. Comparing each value to the unaffected shoulder, we could find these results: 7 excellent, 10 good, 8 fair, and 4 poor. No axillary nerve lesions were clinically detected. The radiographic evaluation showed a complete bone healing in all cases within the first 3 months. No head necrosis was detected, as well as screws loosening. In two cases, the X-ray at 2 months revealed a little loss of reduction in varus. Two patients had an anterior pain; in one of these two cases, the plate was removed.
  
  
  CONCLUSIONS
  In our series, we had no cases of head necrosis, screws cutout, fracture collapse, hardware mobilization, and we think this could be the real advantage of the percutaneous technique compared to the open one, thanks to the reduced biological damage. We had some poor results, related more to patient's age than to other factors. The safety of the technique for the axillary nerve is demonstrated in the literature and confirmed by our experience.
  
  
  CONCLUSIONS
  Percutaneous plating of proximal humeral fractures with NCB-PH plate has demonstrated to be a good strategy in managing these lesions without increasing complications.
authors.affiliation: Orthopedics and Traumathology Department, Ospedale Regina Montis Regalis, Via Rocchetto 99, Mondovì, CN, Italy. d.imarisio@libero.it
authors.forename: D
authors.initials: D
authors.lastname: Imarisio
authors.forename: A
authors.initials: A
authors.lastname: Trecci
authors.forename: L
authors.initials: L
authors.lastname: Sabatini
authors.forename: R
authors.initials: R
authors.lastname: Scagnelli
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome