{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:23Z","timestamp":1787755463658,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>A minority of proximal humeral fractures extend into the diaphysis and their optimal treatment remains controversial. We evaluated the outcomes and risk of complications in patients with these injuries, treated by a protocol of open reduction and long locking plate fixation (LPF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between 2007 and 2014, all locally resident patients with a proximal humeral fracture extending into the diaphysis were referred to a specialist shoulder clinic. Operative treatment using a protocol of open reduction and LPF was offered to medically fit patients. Those with 2-year radiographic follow-up were included in the study, and standardized assessments of clinical and radiographic outcomes were performed during the first 2 years postoperatively. At a mean of 8.8 years (range, 5 to 12 years) after LPF, the functional outcomes and satisfaction of surviving, cognitively intact patients were assessed with a questionnaire study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One hundred and two patients met the inclusion criteria; the majority were older women who had incurred the injury during a simple fall. Fractures were divided into 2 types depending on the pattern of diaphyseal extension. The pain levels, functional scores, and satisfaction with treatment were satisfactory both at the 2-year follow-up and at the longer-term follow-up at a mean of 8.8 years postsurgery. Complications were predominantly due to postsurgical stiffness (in 7 patients, with 3 undergoing additional surgery) and nonunion or fixation failure (in 7 patients, with 6 undergoing additional surgery).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Proximal humeral fractures with diaphyseal extension are rare. The results of our study support the use of LPF in medically stable patients in centers with the expertise to perform these procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.00372","type":"journal-article","created":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T17:25:37Z","timestamp":1602782737000},"page":"2146-2156","source":"Crossref","is-referenced-by-count":10,"title":["Open Reduction and Long Locking Plate Fixation of Complex Proximal Humeral Metadiaphyseal Fractures"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6879-7026","authenticated-orcid":false,"given":"C. Michael","family":"Robinson","sequence":"first","affiliation":[{"name":"The Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3857-8628","authenticated-orcid":false,"given":"Paul H.C.","family":"Stirling","sequence":"additional","affiliation":[{"name":"The Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2682-1408","authenticated-orcid":false,"given":"Deborah J.","family":"MacDonald","sequence":"additional","affiliation":[{"name":"The Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1072-1595","authenticated-orcid":false,"given":"Jason A.","family":"Strelzow","sequence":"additional","affiliation":[{"name":"The Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9583-8524","authenticated-orcid":false,"given":"Ewan B.","family":"Goudie","sequence":"additional","affiliation":[{"name":"The Edinburgh Shoulder Clinic, New Royal Infirmary of Edinburgh, Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"issue":"4","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/j.1758-5740.2010.00085.x","article-title":"Long PHILOS plate fixation for complex humeral fractures","volume":"2","author":"Pimple","year":"2010","journal-title":"Shoulder Elbow."},{"issue":"12","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.injury.2010.07.235","article-title":"Minimal invasive long PHILOS\u00ae-plate osteosynthesis in metadiaphyseal fractures of the proximal humerus","volume":"41","author":"Rancan","year":"2010","journal-title":"Injury."},{"issue":"1","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/1758573214540638","article-title":"Long contoured locking plate fixation of traumatic proximal humeral fractures with distal extension","volume":"7","author":"George Malal","year":"2015","journal-title":"Shoulder Elbow."},{"issue":"8","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s00590-013-1324-9","article-title":"Long PHILOS plate fixation in a series of humeral fractures","volume":"24","author":"Arumilli","year":"2014","journal-title":"Eur J Orthop Surg Traumatol."},{"issue":"5","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s00264-006-0242-4","article-title":"Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture","volume":"31","author":"Lau","year":"2007","journal-title":"Int Orthop."},{"issue":"1","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.injury.2004.03.023","article-title":"Helical plate fixation for treatment of comminuted fractures of the proximal and middle one-third of the humerus","volume":"36","author":"Yang","year":"2005","journal-title":"Injury."},{"issue":"1","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s13018-018-0908-9","article-title":"Proximal third humeral shaft fractures fixed with long helical PHILOS plates in elderly patients: benefit of pre-contouring plates on a 3D-printed model-a retrospective study","volume":"13","author":"Wang","year":"2018","journal-title":"J Orthop Surg Res."},{"key":"bib8-20230714","doi-asserted-by":"crossref","first-page":"184","DOI":"10.2174\/1874325001206010184","article-title":"Minimally invasive helical plating for shaft of humerus fractures: technique and outcome","volume":"6","author":"Tan","year":"2012","journal-title":"Open Orthop J."},{"issue":"Suppl 1","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Introduction: fracture and dislocation classification compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1097\/BOT.0b013e3181589f8c","article-title":"The anterolateral acromial approach for fractures of the proximal humerus","volume":"22","author":"Gardner","year":"2008","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.injury.2008.05.031","article-title":"Assessment of axillary nerve function and functional outcome after fixation of complex proximal humeral fractures using the extended deltoid-splitting approach","volume":"40","author":"Khan","year":"2009","journal-title":"Injury."},{"issue":"9","key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/BOT.0b013e3180ce833e","article-title":"The extended deltoid-splitting approach to the proximal humerus","volume":"21","author":"Robinson","year":"2007","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1302\/0301-620X.93B3.25818","article-title":"The extended deltoid-splitting approach to the proximal humerus: variations and extensions","volume":"93","author":"Robinson","year":"2011","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib14-20230714","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.injury.2016.10.044","article-title":"Osteosynthesis for clavicle fractures: how close are we to penetration of neurovascular structures?","volume":"48","author":"Stillwell","year":"2017","journal-title":"Injury."},{"issue":"23","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.2106\/JBJS.19.00595","article-title":"Complications and long-term outcomes of open reduction and plate fixation of proximal humeral fractures","volume":"101","author":"Robinson","year":"2019","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib16-20230714","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1302\/0301-620X.92B5.22849","article-title":"Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate","volume":"92","author":"Robinson","year":"2010","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib17-20230714","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1302\/0301-620X.78B4.0780593","article-title":"Questionnaire on the perceptions of patients about shoulder surgery","volume":"78","author":"Dawson","year":"1996","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib18-20230714","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1177\/1753193413481302","article-title":"The DASH and the QuickDASH instruments. Normative values in the general population in Norway","volume":"39","author":"Aasheim","year":"2014","journal-title":"J Hand Surg EurVol."},{"issue":"4","key":"bib19-20230714","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jse.2004.01.034","article-title":"Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus","volume":"13","author":"Hertel","year":"2004","journal-title":"J Shoulder Elbow Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00372","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:25Z","timestamp":1787751805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,15]]},"references-count":19,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.00372","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,15]]}}}