Retrospective study of 35 patients treated with locked plating for proximal humerus fractures. Asked which factors predict maintenance of fracture reduction, measured as change in humeral head height relative to the plate from postop radiograph to healing. Medial column support was the primary variable of interest.
Early locked plating series showed variable results — varus collapse and screw cutout were common, but no one had identified which intraoperative factor was responsible. This paper answered that question directly.
When you plate a proximal humerus fracture, medial column support is the one thing you must verify before closing. Anatomic cortical reduction is ideal. When medial comminution prevents cortical contact, impacting the shaft laterally into the head or deliberately placing an oblique locking screw into the inferomedial quadrant within 5 mm of subchondral bone achieves the same mechanical goal.
Do not expect calcium phosphate cement to compensate for absent medial support. It provided no reduction benefit in this series. And do not assume the elderly patient with a 4-part fracture is doomed: age and fracture pattern were not predictors of failure when medial support was established.
This paper established the inferomedial oblique screw as a deliberate, named technical target in proximal humerus locked plating. The concept is now standard teaching in trauma curricula and directly informs how plate position is chosen relative to screw trajectory, not just lateral cortex fit.
Retrospective study of 35 patients treated with locked plating for proximal humerus fractures. Asked which factors predict maintenance of fracture reduction, measured as change in humeral head height relative to the plate from postop radiograph to healing. Medial column support was the primary variable of interest.
Early locked plating series showed variable results — varus collapse and screw cutout were common, but no one had identified which intraoperative factor was responsible. This paper answered that question directly.
When you plate a proximal humerus fracture, medial column support is the one thing you must verify before closing. Anatomic cortical reduction is ideal. When medial comminution prevents cortical contact, impacting the shaft laterally into the head or deliberately placing an oblique locking screw into the inferomedial quadrant within 5 mm of subchondral bone achieves the same mechanical goal.
Do not expect calcium phosphate cement to compensate for absent medial support. It provided no reduction benefit in this series. And do not assume the elderly patient with a 4-part fracture is doomed: age and fracture pattern were not predictors of failure when medial support was established.
This paper established the inferomedial oblique screw as a deliberate, named technical target in proximal humerus locked plating. The concept is now standard teaching in trauma curricula and directly informs how plate position is chosen relative to screw trajectory, not just lateral cortex fit.