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Which parameters affect medium- to long-term results after angular stable plate fixation for proximal humeral fractures?

Abstract：

BACKGROUND:Very little information on medium- to long-term results is available for surgically treated proximal humeral fractures. The aim of this prospective treatment study was to present long-term results after angular stable plate fixation of displaced proximal humeral fractures and to detect which specific patient- and fracture-related parameters affect the clinical outcome. METHODS:We performed a prospective clinical and radiologic evaluation of 77 patients with a displaced proximal humeral fracture (28 Neer 2-part, 38 3-part, and 11 4-part fractures; 28 AO A fractures, 30 AO B fractures, and 19 AO C fractures) treated with angular stable plate fixation after a mean follow-up period of 96 months (range, 74-133 months). We assessed outcomes with the Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and evaluated specific patient- and fracture-related parameters including complications. RESULTS:The mean Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 79, 31, and 12 points. Reasons for revisions were implant-related impingement (n = 13), screw perforation (n = 10), infection (n = 4), and secondary fracture displacement (n = 1). There was a significant association between worse score results and occurrence of secondary fracture displacement, screw perforation, residual bone deformities, and a rotator cuff defect at follow-up. CONCLUSIONS:Good medium- to long-term results after angular stable plate fixation of displaced proximal humeral fracture can be expected. A reconstruction within a range of 15° in both anteroposterior and axillary views and <5-mm tuberosity displacement should be the aim of head-preserving surgery to prevent complications, such as secondary fracture displacement and screw perforation, and a less favorable long-term result.

journal_name

J Shoulder Elbow Surg

journal_title

Journal of shoulder and elbow surgery

authors

Bahrs C,Kühle L,Blumenstock G,Stöckle U,Rolauffs B,Freude T

doi

10.1016/j.jse.2014.08.009

subject

Has Abstract

pub_date

2015-05-01 00:00:00

pages

727-32

issue

5

eissn

1058-2746

issn

1532-6500

pii

S1058-2746(14)00456-X

journal_volume

24

pub_type

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