title: Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff.
abstract: OBJECTIVE
  This study retrospectively reports the results of 81 patients with proximal humeral fractures that were treated operatively. We hypothesized that treatment of these injuries through a standardized technique of precountored locked plating and supplemental tension band suture fixation would result in improved clinical outcomes.
  
  
  METHODS
  All patients were evaluated with a minimum follow-up of 1 year. Clinical assessment was performed postoperatively with American Shoulder and Elbow Surgeons (ASES) scores and active range of motion measurements. Radiographic parameters assessed included Neer fracture pattern, fracture union, hardware failure, the presence of avascular necrosis, and medial calcar length and stability. Fractures were classified as 4-part in 14 (17%), 3-part in 41 (51%), and 2-part in 26 (32%).
  
  
  RESULTS
  The average ASES score was 80 (range, 27-100). The final range of motion averaged 131° of anterior elevation and 41° of external rotation. Fracture union was achieved in all patients, and there were no tuberosity failures. Complications included intraarticular screw penetration in 3 (3.7%) and avascular necrosis in 5 (6.2%).
  
  
  CONCLUSIONS
  Locked plating and supplemental tension band fixation can lead to fracture union and favorable outcomes. Restoration of the medial calcar and supplemental suture fixation may decrease the incidence of hardware-related complications.
authors.affiliation: UAP Bone and Joint Union Hospital, Terre Haute, IN, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Badman
authors.forename: Mark
authors.initials: M
authors.lastname: Frankle
authors.forename: Christopher
authors.initials: C
authors.lastname: Keating
authors.forename: Leanne
authors.initials: L
authors.lastname: Henderson
authors.forename: Jordan
authors.initials: J
authors.lastname: Brooks
authors.forename: Mark
authors.initials: M
authors.lastname: Mighell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult