Salvage of an Existing Construct With Stacked Plating

Case Report

Austin J Musculoskelet Disord. 2016; 3(1): 1029.

Salvage of an Existing Construct With Stacked Plating

Hsi-Ting Lin¹ and Andy Li-Jen Liu²*

1Department of Orthopedic Surgery, Cathay General Hospital, Taipei, 10689, Taiwan, ROC

2Department of Orthopedic Surgery, Hope Doctors Hospital, Taiwan, R.R.China

*Corresponding author: Andy Li-Jen Liu, Department of Orthopedic Surgery, Hope Doctors Hospital, No. 125, Xindong Street, Miaoli City, 36052, Taiwan, R.R.China

Received: December 01, 2015; Accepted: March 11, 2016; Published: March 14, 2016


Fracture fixation with double plating has been well documented. We report an 82-year-old female who suffered a proximal humerus fracture who was treated surgically with locking plate and screws. Unfortunately, patient fell seven weeks later and suffered a peri-implant humeral shaft fracture at the junction of the proximal and middle third just around the most distal screw from the initial surgery. Because the previous fracture had not healed completely and removing the prosthesis would probably cause a collapse of the previous reduction, a decision was made to stack an exact but longer proximal humeral locking plate for fixation. After three months of follow up, patient has achieved functional recovery with satisfactory ranges of motion in her right shoulder. This outcome demonstrates that salvage of an existing construct with stacked plating can work as an alternative method of fixation when other options are less appropriate.

Keywords: Overlap plates; Proximal humerus fracture; Stacked plates; Veterinary cuttable plates


Most salvage procedures involving a pre-existing construct usually requires the removal of the original prosthesis followed by the application of a new one after proper reduction and fixation have been performed. However, when the removal of the original construct is not suitable, an alternative method must be available. Depending on the type of fracture, orthogonal double plates and overlapping connecting plates have proven effective [1-6]. we present an unusual case report describing the salvage of an existing construct with stacked plating. Even though it has been commonly used for fracture repair in small animals, its application in human fracture fixation has been limited and does provide worthwhile and novel information for the orthopedic surgeon seeking different treatment options. A search of literature shows that only a handful of similar articles have ever been published [4-11].

Case Report

Patient is an 82-year-old woman who fell while strolling through the park. She entered the emergency department (ER) complaining of extreme pain on her right upper arm. Physical examination revealed abundant ecchymosis around the arm and chest, tenderness upon palpation, and limited Range of Shoulder Motion (ROM). No neurovascular abnormalities were noted. Initial radiograph of the right upper arm revealed a proximal humerus fracture with severe comminution of the humeral head (Figure 1). Considering the age of the patient, the severity of the fracture, and the osteoporotic quality of her bone, a hemiarthroplasty would be the treatment of choice. However, after informing the patient of the benefits and risks of such procedure, she decided that restoring shoulder motion, function and strength as close to her pre-injury levels as possible would suit her active lifestyle better. Therefore, Open Reduction and Internal Fixation (ORIF) were performed. During surgery, with the help of both allogenic and artificial bone grafts, the fracture was reduced and fixated with a proximal humerus internal locking system (PHILOS) plate (Synthes, Switzerland). Postoperatively, the radiograph showed good alignment and the arm was immobilized with a shoulder sling (Figure 2).