VOLT™ Proximal Humerus Plating System
Simon Lambert, Frank Beeres, Joyce Koh, Stefaan Nijs, Martin Jaeger, Chunyan Jiang, Harry Hoyen
Approved by the AO Technical Commission in 2024, the VOLT™ Proximal Humerus Plating System addresses complex fractures of the proximal humerus. The newly designed plate holes feature locking with Variable Angle Optimized Locking Technology (VOLT™) which allows improved screw positioning (Fig 1) and improved flexibility in plate placement.
Enhanced design features of the plates include elongated combi holes which aid in plate positioning and accept both locking and cortex screws and limited-contact undercuts on the plate shaft. The new system features an expanded implant selection and offers a range of plate lengths to address a wider range of patients and fracture situations.
In the new plates, suture holes around the proximal end have been redesigned to allow the rotator cuff muscles to be more easily secured to the plate after implant insertion (Fig 2a). The system includes 3.5mm VOLT™ Locking Screws which feature an atraumatic tip (Fig 2b) designed to reduce the risk of soft tissue irritation compared to LCP.
Instrumentation has been improved with new, streamlined guide blocks addressing both deltopectoral and deltoid split approaches. A new length probe facilitates three different techniques for precise measuring.
System Overview: Plates and Screws
VOLT™ Proximal Humerus Plates are available in short (3 & 5 hole) and long (5, 6, 7, 8, 9, 10, 11, 12, 13 hole) versions (Fig 3). All plate lengths are available in stainless steel and titanium and are compatible with VOLT™ 3.5mm locking screws, 3.5mm cortex screws and 4.0mm cancellous screws. All implants feature 3.5mm VOLT™ locking and combi-holes.
Features and benefits
The design features of the new VOLT™ Proximal Humerus Plating System offer many benefits to both patients and surgeons:
Precision locking with VOLT™ Variable Angle Locking Technology allows improved calcar screw positioning, more adjustability in plate placement - which is especially critical in smaller patients - and increased overall construct stability.
The new length probe facilitates easier measuring of proximal screws and reduces the risk of screw penetration when bone quality is poor.
The risk of interference with the axillary nerve is reduced when using the short guide block with the deltoid split approach.
The new system is compatible with the VOLT™ Small Fragment platform of instruments with identical color-coding and a platform design approach. The ease of use facilitates training and adoption by surgeons and ORP, making instrument identification intuitive and reducing surgical delay.
Indications (US)
The VOLT Proximal Humerus Plating 3.5 System is indicated for internal fixation of proximal humerus fractures in adults and adolescents (12-21 years) where growth plates have fused.
VOLT Proximal Humerus Plates are indicated for fractures of the proximal end segment of the humerus.
VOLT Proximal Humerus Plates, Long are indicated for fractures of the proximal end segment and/or diaphyseal segment of the humerus.
Indications (EU)
VOLT Proximal Humerus Plates are indicated for internal fixation of fractures of the proximal end segment of the humerus.
VOLT Proximal Humerus Plates, Long are indicated for internal fixation of fractures of the proximal end segment and/or diaphyseal segment of the humerus.
Contraindications
No contraindication specific to these devices.
System Overview: Instruments
The VOLT™ Proximal Humerus Instruments include guide blocks, a length probe, a triple trocar, an outer sleeve for guided screw insertion, and 3- and 12-hole sizing templates. The streamlined guide block design is available in both a standard and short size (Fig 4), addressing both deltopectoral and deltoid split surgical approaches. The length probe offers versatility and precision with three measuring techniques: guide block (nominal angle), threaded drill guide (nominal angle) and locking drill guide (free hand, variable angle), depending on anatomic requirements.
Clinical Case: VOLT™ Proximal Humerus Plating System
Case kindly provided by Harry Hoyen, M.D. Metro Health Medical Center, Department of Orthopaedic Surgery, Cleveland Ohio, US.
A 24-year-old woman presented to the emergency room following a motor vehicle accident. X-rays on the day of admission (Fig 1a-c) showed a fracture to the proximal humerus. There was some varus displacement of the humerus with involvement of the surgical neck and greater tuberosity.
The patient was treated with open reduction and internal fixation (ORIF). First, the fracture was reduced (Fig 2a-b). There was an attempt at closed reduction with continued displacement. Then an open reduction through a deltopectoral approach was performed. After direct reduction, a 1.6 mm K wire was placed along the anterolateral humeral surface. The provisional plate placement and reduction are depicted in Fig 3.
Definitive fixation was performed with a 3-hole VOLT™ Proximal Humerus plate (Fig 4). The plate was placed just beneath the rotator cuff insertion to directly support the greater tuberosity component. The proximal screws angulated toward the superior head to maximize length. The calcar screws were placed in a slightly splayed trajectory. One of the angular stable variable angled screws in the central portion was angulated in a posterior and more central position. This permitted maximal screw spread within the humeral head.
The patient was managed with sling immobilization for 2-3 weeks postoperatively. Early motion was permissible as the fracture was stable after fixation.
Three months after surgery, the patient had good elevation in the scapular plane to 130 degrees. External rotation was measured at 30 degrees, with more limited internal rotation (to the belt line). X-ray imaging (Fig 5) showed maintenance of fracture alignment and no change in screw position. The axial view (Fig 5c) highlights the subchrondral position of the variable angular screws in the humeral head. The patient was progressing nicely with functional tasks and adding weight in her therapy program.
VOLT™ Proximal Humerus Plating System
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