Dual Column Fixation in Comminuted Proximal Humerus Fracture – Can It Be an Alternative

Objectives: To prove that complex proximal humerus fractures with metaphyseal comminution, when fixed in two planes, i.e., standard coronal and secondary sagittal plane, prevent fixation failure and better functional outcomes. Materials and Methods: This was a prospective cohort study. Setting: KIMS ‐ Sunshine Hospitals, Secunderabad, Telangana, India. Patients/Participants: All patients ranging between 20 and 70 years of age and Arbeitsgemeinschaft für Steosynthesefragen/Orthopedic Trauma Association 11 (B1.2, B1.3, C3.1, C3.2, C3.3) types of fractures. Forty‐one patients fitting the above inclusion criteria from the years 2018 to 2020 were included in this study. Intervention: Through the deltopectoral approach, standard lateral plating with an anterior or posterior plate, depending on the side of metaphyseal comminution, was done for fracture fixation. Main Outcome Measurements: In all patients, the outcome was measured using the University of California at Los Angeles (UCLA) score, visual analog score at the 18-month postoperative period, and neck–shaft angles radiologically, which were measured immediately postoperatively and at 18 months postoperative period. Results: There was a 100% union rate in this series with an average union time of 13.9 weeks. At 18 months, the UCLA score is excellent to good in 90% of cases. The neck–shaft angles are maintained in all 41 cases, indicating no collapse. Conclusions: This study suggests that a second plate in a different plane provides better construct strength, preventing collapse and achieving a better functional outcome, with no additional exposure. Level of Evidence: Therapeutic level 2.