Role of locking plate in fractures of shaft of humerus in elderly patients

Author(s): Dr. Vinod Kanithi, Dr. K Adithya and Dr. K Satya Kumar

Abstract: Fractures of humeral diaphysis constitute 3% of all the bony injuries. Operative technique which have been devised for the treatment of humeral diaphyseal fractures include ORIF with plate osteosynthesis, intramedullary nailing and External fixation using ilizarov ring fixators or AO tubular fixators. Open reduction and internal fixation with plate osteosynthesis supplemented with bone grafting has been the gold standard for treatment of the humeral diaphysis when other methods are compared. The key to this new generation of plates is the locking mechanism of the screw to the plate, which provides angular stability and avoids compression of the plate to the periosteum. Loss of screw purchase is an important factor related to the failure of fixation in osteo porotic bone. Fracture plating technology recently has evolved to include locked plating. The main goal is to obtain the most rigid fixation possible. It is a prospective study of 30 elderly patients who attended either the outpatient department or emergency room who had sustained injury to the arm and diagnosed as facture shaft of humerus in NRI Medical college and general hospital during the period of 2 years (November 2016 to October 2018). All the cases followed at 6weeks, 3 months and at 12months. The results are assessed by Constant and Murley’s scoring system. Post-menopausal osteoporotic females accounted for 40% of patients. In our study internal fixation using locking compression plating techniques achieved union in all cases. 95% of fractures united within 16 weeks. The functional outcome was more than 90%. These results are comparable with those obtained by R Vander Griend et al open reduction and internal fixation using AO plating techniques (97%). Treatment of long bone fractures with osteoporosis in elderly patients is technically challenging in terms of fracture fixation, maintainance of reduction and achieving bony union with good clinical outcome. Locking Compression Plate offers higher weight bearing capacity than the conventional plates interms of good fixation and stability. In osteoporosis or poor bone quality, bicortical engagement of screws is recommended.

DOI: https://doi.org/10.22271/ortho.2019.v5.i2p.1476