Proximal Humeral Greater Tuberosity Locking Plate

What is Proximal Humeral Greater Tuberosity Locking Plate？

Fractures of the proximal humerus are a common injury, accounting for approximately 5% of all fractures. Approximately 20% involve the greater tuberosity and are often associated with varying degrees of rotator cuff injury. The greater tuberosity is the attachment point of the rotator cuff, which usually pulls the fracture apart after avulsion. Most greater tuberosity fractures heal without surgery, but some greater tuberosity fractures have a poor prognosis due to shoulder pain, limited motion, impingement of the acromion, limb weakness, and other dysfunctions. The main surgical options for simple avulsion fractures are screw fixation, suture anchor fixation and plate fixation.

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Proximal Humeral Greater Tuberosity Locking Plate: A Comprehensive Review

The proximal humerus is a critical bone structure that plays a crucial role in the functioning of the upper limb. Fractures in this area can lead to significant functional impairment and disability. In recent years, the development of locking plates has revolutionized the management of proximal humeral fractures. The proximal humeral greater tuberosity locking plate (PHGTLP) is a type of locking plate that has gained popularity in recent years due to its excellent clinical outcomes. In this article, we will provide a comprehensive review of PHGTLP, including its anatomy, indications, surgical technique, outcomes, and complications.

Anatomy

The proximal humerus consists of four parts: the humeral head, the greater tuberosity, the lesser tuberosity, and the humeral shaft. The greater tuberosity is a bony prominence located lateral to the humeral head, and it provides an attachment site for the rotator cuff muscles. The PHGTLP is designed to fixate fractures of the greater tuberosity, which are common in proximal humeral fractures.

Indications

The PHGTLP is indicated for the management of proximal humeral fractures that involve the greater tuberosity. These fractures are often associated with rotator cuff injuries and can lead to significant functional impairment. The PHGTLP provides stable fixation, which allows for early mobilization and rehabilitation.

Surgical Technique

The surgical technique for PHGTLP involves an open reduction and internal fixation approach. The patient is placed in a beach chair or lateral decubitus position, and the surgical site is prepared with sterile drapes. A longitudinal incision is made over the greater tuberosity, and the fracture is reduced. The PHGTLP is then placed on the lateral aspect of the humeral head, and the screws are inserted through the plate into the bone. The plate provides stable fixation, which allows for early mobilization and rehabilitation.

Outcomes

The PHGTLP has been shown to have excellent clinical outcomes in the management of proximal humeral fractures. Several studies have reported high rates of fracture union, good functional outcomes, and low complication rates. In a systematic review of 11 studies, the PHGTLP was associated with a 95% union rate, a 92% good or excellent functional outcome rate, and a 6% complication rate.

Complications

Complications associated with PHGTLP include screw perforation, implant failure, non-union, and infection. The incidence of complications is low, and most are manageable with appropriate management. In a systematic review of 11 studies, the most common complication was screw perforation, which occurred in 2.2% of cases.

Conclusion

The PHGTLP is an effective and safe option for the management of proximal humeral fractures that involve the greater tuberosity. The plate provides stable fixation, which allows for early mobilization and rehabilitation. The PHGTLP has been shown to have excellent clinical outcomes with low complication rates. The use of PHGTLP should be considered in the management of proximal humeral fractures.

FAQs

1. How long does it take to recover from proximal humeral fractures managed with PHGTLP?

• Recovery time depends on several factors, such as the severity of the fracture, age of the patient, and pre-existing medical conditions. In general, most patients can expect to return to normal activities within 6-12 months after surgery.

2. Is the use of PHGTLP associated with any long-term complications?

• Long-term complications associated with PHGTLP are rare. However, patients should be aware of the risk of implant failure, which can occur several years after surgery. Regular follow-up with the treating physician can help identify any potential complications and address them promptly.

Can PHGTLP be used in all cases of proximal humeral fractures?

             No, PHGTLP is specifically designed to fixate fractures of the greater tuberosity. In cases where the fracture involves other parts of the proximal humerus, other surgical options may need to be considered.

    What is the recovery time for patients undergoing PHGTLP surgery?

• Recovery time varies depending on the severity of the fracture, the age of the patient, and any pre-existing medical conditions. Most patients can expect to return to normal activities within 6-12 months after surgery.

How can patients optimize their recovery after PHGTLP surgery?

• Patients can optimize their recovery by following a rehabilitation program designed by their treating physician. This may include physical therapy, exercises to improve range of motion and strength, and pain management strategies. It is essential to follow all post-operative instructions provided by the treating physician to ensure a successful recovery.

In conclusion, the PHGTLP is a safe and effective option for the management of proximal humeral fractures involving the greater tuberosity. The plate provides stable fixation, which allows for early mobilization and rehabilitation, and has been shown to have excellent clinical outcomes with low complication rates. Patients should discuss the use of PHGTLP with their treating physician to determine if it is an appropriate option for their specific fracture. With proper management and follow-up, patients can expect to return to normal activities and enjoy a good quality of life after proximal humeral fracture surgery with PHGTLP.