title: Pitfalls and complications with locking plate for proximal humerus fracture.
abstract: OBJECTIVE
  The aim of this study was to identify specific complications of locking plate fixation of proximal humerus fractures.
  
  
  METHODS
  Seventy-three adult patients with a displaced 3- (24%) or 4-part (76%) fracture of the proximal humerus were treated over a period of 2 years under the supervision of a trauma surgeon. Fourty-four patients came back for a clinical and radiographic examinations at least 18 months after the trauma; the others were evaluated at 6 weeks and 3 and 6 months.
  
  
  RESULTS
  Out of the 73 patients (64.4% females, mean age of 65), 11 patients needed a second surgery and 18 were lost for follow-up after 6 months. Mean final constant score was 62.3 points. The incidence of secondary displacement was 8.2%. Nonunion rate was 5.5%, affecting the constant score (P = .018). 16.4% of the patients developed a partial necrosis of the humeral head at the latest follow-up, which influenced on the constant score (P = .029). Quality of the reduction of the greater tuberosity influenced final results (P = .037). Screw cutout rate was 13.7%, with an influence to the constant score (P = .001). A too high plate positioning influenced the constant score (P = .002).
  
  
  CONCLUSIONS
  Locked screw-plates provide more secure fixation of fractures, especially in weak bone. Complications rate remains high. Two complications are to be distinguished: 1) technical complications in plate positioning, length of the screws or secondary screw cutout strongly influence the final clinical result; and 2) specific complications related to this technology such as pseudarthrosis or plate fracture.
authors.affiliation: Shoulder and Elbow Service, CCOM-CHU Strasbourg, Illkirch, France. philippe.clavert@chru-strasbourg.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Clavert
authors.forename: Philippe
authors.initials: P
authors.lastname: Adam
authors.forename: Adrien
authors.initials: A
authors.lastname: Bevort
authors.forename: François
authors.initials: F
authors.lastname: Bonnomet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Kempf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D001860:Bone Plates / Q000009:adverse effects*; D002062:Bursitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013997:Time Factors