Intramedullary Plating of Complex Proximal Humerus Fractures: A Case Series - Letter to Editor

Abstract: We commend McDonald et al. for their innovative technique using intramedullary plating for complex proximal humerus fractures, particularly addressing the challenge of calcar comminution. Our approach, using an anterior deltoid split, contrasts with the deltopectoral method, offering enhanced lateral exposure and minimizing vascular disruption, thus facilitating fracture reduction. The displaced tuberosities allow for direct visualization, enabling secure intramedullary plate placement. Emphasizing robust humeral head support, we advocate for both proximal and distal plate fixation to maintain the neck-shaft angle during early rehabilitation. In elderly or osteoporotic patients, combining an intramedullary plate with allograft bone grafting significantly improves fracture stability and union rates, aligning with established biomechanical principles. This approach, supported by previous studies, underscores the efficacy of comprehensive fixation strategies in managing complex proximal humerus fractures.

Keywords:

Intramedullary Plating , Proximal Humerus Fracture , splitting deltoid muscle approach