Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

Charles M. Court-Brown; Margaret McQueen

$To The Editor: We read the article "Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate. Results of a Prospective, Multicenter, Observational Study" (2009;91:1320-8), by Südkamp et al., with interest. The authors have written yet another paper on the advantages and disadvantages of a locking proximal humeral plate and, while we have no doubt that the study was performed well, we believe that they sidestepped the real issue, which is who should be treated with these plates. They reported a mean Constant score of 70.6 one year after surgery in 187 patients with proximal humeral fractures. They did not detail the results for different fracture types, but our analysis of the paper suggests that about 105 fractures were AO type-A2, A3, or B1 fractures, and it seems reasonable to assume that they achieved better results with these simpler fractures than in the AO type-B2, B3, and C fractures that they also treated. We believe that the results reported by Südkamp et al. are no better than those achieved with nonoperative management. In previously published studies 1 , 2 , we documented mean Constant scores of 64, 65, and 72 for AO type-A2, A3, and B1 fractures, respectively, one year after nonoperative management. The mean ages in our groups were seventy-four, sixty-eight, and seventy-one years, respectively, which are considerably older than the mean age of sixty-three years for Dr. Südkamp's patients. Age is obviously very important to outcome. We documented a mean Constant score of 75.7 in patients with type-B1 fractures who were sixty to sixty-nine years of age compared with a mean score of 67.1 in patients who were eighty to eighty-nine years of age 1 . When age is considered, we believe that there is no evidence that the locking plate actually improves the outcome in most patients. We do not doubt that there are patients with proximal humeral fractures who benefit from surgery and that the fracture type, age, and general mobility of the patient and the presence of clinical and social comorbidities influence surgeons in their choice of treatment. However, the literature is deficient in helping us to consider which fractures will do better with surgical treatment. This is important as proximal humeral fractures are common and are getting more common as the prevalence of osteoporotic fractures increases. It is important that shoulder surgeons and trauma surgeons start doing more than simply assessing yet another plate. <h2>References</h2>$

Open Reduction and Internal Fixation of Proximal Humeral Fractures with Use of the Locking Proximal Humerus Plate

Court-Brown, Charles M.; McQueen, Margaret

Follow Journal of Bone and Joint Surgery , Volume 91 (11): 2771 JB&JS – Nov 1, 2009