Pitfalls and complications with locking plate for proximal humerus fracture.
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.
Clavert
Philippe
P
Shoulder and Elbow Service, CCOM-CHU Strasbourg, Illkirch, France. philippe.clavert@chru-strasbourg.fr
Adam
Philippe
P
Bevort
Adrien
A
Bonnomet
François
F
Kempf
Jean-François
JF
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