One-Year Follow-Up After Treatment of Proximal and/or Middle One-Third Humeral Shaft Fractures with a Helical Plate: Healing Rates, Complications and Functional Outcome Measures

Abstract

\n Background: Conventional plate osteosynthesis is a valuable treatment option in displaced proximal and/or middle one-third humeral shaft fractures. Nonetheless, this procedure can be complicated by a radial nerve palsy. To date, many surgical techniques have been developed in an attempt to minimize this high-impact complication. However, a helical plate has the potential to avoid an iatrogenic radial nerve palsy due to its design. This article aims to evaluate safety and functional outcomes of patients treated with a helical plate compared to conventional plate osteosynthesis. In particular healing rates, complications and functional outcome measures.Methods: We retrospectively included all patients with displaced proximal and/or middle one-third humeral shaft fractures who were treated with a helical plate from October 2016 until August 2018 at a single level-1 trauma center (AZ Groeninge, Kortrijk, Belgium). A self-molded long PHILOS plate (DePuy Synthes®) or a pre-contoured A.L.P.S proximal humeral plating system (Zimmer Biomet®) were used. Patient baseline characteristics and standard radiographs were obtained pre- and postoperatively. We retrospectively searched for complications. Patients were reassessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Constant Murley (CMS) and EQ-5D-5L scores with a minimal follow-up of one year.Results: The humeral shaft fractures of all sixteen patients consolidated within three months and no iatrogenic radial nerve palsies were observed. One plate had to be removed after one year due to a late infection. With a minimum follow up of one year, the mean DASH score was 22 \\ 19 and the mean normalized CMS was 80 B 19.Conclusion: Operative treatment of proximal and/or middle one-third humeral shaft fractures with a helical plate is a safe procedure with good to excellent shoulder function at one-year follow-up. Contrary to conventional plate osteosynthesis, a helical plate has the potential to completely avoid a radial nerve palsy, while maintaining similar healing rates and functional outcomes.Trial registration: B396201939564. Registered on 6 MAY 2019 – retrospectively registred. Ethics Committee: Medical Ethics Committee, AZ Groeninge, Kortrijk, Belgium.