title: The bicipital groove as a landmark for reconstruction of complex proximal humeral fractures with hybrid double plate osteosynthesis.
abstract: BACKGROUND
  Complex proximal humerus fractures with metaphyseal comminution remain challenging regarding reduction and stability. In most fracture patterns the hard bone of the bicipital groove remains intact. In this case series, we describe a novel technique of hybrid double plate osteosynthesis of complex proximal humerus fractures with metaphyseal comminution.
  
  
  METHODS
  In randomly chosen shoulder specimens and synthetic bones, pilot studies for evaluation of the feasibility of the technique were performed. Between 4/2010 and 1/2012 10 patients underwent hybrid double plate osteosynthesis. Seven patients (4 male, 3 female, mean age was 50 years (range 27-73)) were available for retrospective analysis. Based on plain radiographs (anterior-posterior and axial view), the fractures were classified according to the Orthopaedic Trauma Association classification (OTA) and by descriptive means (head-split variant (HS), diaphyseal extension or comminution (DE)).
  
  
  RESULTS
  Follow-up radiographs demonstrated complete fracture healing in six patients and one incomplete avascular necrosis. None of the patients sustained loss of reduction. Three patients where reoperated. The medium, not adapted, Constant score was 80 Points (58-94). Patients subjective satisfaction was graded mean 3 (range: 0-6) in the visual analog scoring system (VAS).
  
  
  CONCLUSIONS
  The technique of hybrid double plate osteosynthesis using the bicipital groove as anatomic landmark may re-establish shoulder function after complex proximal humerus fractures in two dimensions. Firstly the anatomy is restored due to a proper reduction based on intraoperative landmarks. Secondly additional support by the second plate may provide a higher stability in complex fractures with metaphyseal comminution.
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. Jan.theopold@medizin.uni-leipzig.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Theopold
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Marquaß
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Fakler
authors.affiliation: Institute of Anatomy, University of Leipzig, Liebigstrasse 13, 04103, Leipzig, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Steinke
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Josten
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hepp
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Double plate; Locked plate; Metaphyseal comminution; Proximal humerus fracture