title: Humeral head necrosis rate at mid-term follow-up after open reduction and angular stable plate fixation for proximal humeral fractures.
abstract: BACKGROUND
  Short-term follow-up of angular stable fixation for proximal humeral fractures has been well documented in the literature. Longer follow-up series are difficult to find. However, especially regarding the risk of avascular humeral head necrosis longer follow-up series are high of clinical relevance.
  
  
  METHODS
  Forty-eight patients with a mean age of 66 years and treated with open reduction and angular stable internal fixation for proximal humeral fractures were followed up for a mean of 45 months. The clinical and radiographic follow-up (Constant Score (CS), age and gender related Constant Score (agCS), Constant Score in comparison to the contralateral side (%CS) and shoulder anterior-posterior and lateral view and axial view X-rays) was performed postoperatively.
  
  
  RESULTS
  Clinical results after 45 months showed a mean CS of 66.2+/-15.4 points with a mean agCS of 90.0+/-23.1%. Evaluation of the %CS showed 77.7+/-17.8%. %CS results showed no significant differences after 45 months in comparison to those obtained after 12 months. However, incidence of avascular necrosis of the humeral head doubled over the follow-up period from 4 cases at 12 months follow-up to 9 cases at final follow-up.
  
  
  CONCLUSIONS
  Results of open reduction and internal fixation with angular stable implants for proximal humeral fractures are reliable, however long-term complications such as avascular necrosis of the humeral head need to be evaluated further on since its incidence increases over the time.
authors.affiliation: Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Stefan.greiner@charite.de
authors.forename: S
authors.initials: S
authors.lastname: Greiner
authors.forename: M J
authors.initials: MJ
authors.lastname: Kääb
authors.forename: N P
authors.initials: NP
authors.lastname: Haas
authors.forename: H J
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome