title: Rate of avascular necrosis following proximal humerus fractures treated with a lateral locking plate and endosteal implant.
abstract: BACKGROUND
  Treatment of displaced proximal humerus fractures remains challenging. The introduction of locking plates has renewed interest in treating these fractures with joint-preserving techniques rather than hemiarthroplasty, but high complication rates are still reported. Avascular necrosis is not solely dependent on the initial fracture pattern, but can also result from intraoperative and postoperative vascular insults.
  
  
  METHODS
  We describe a technique to minimize disruption of humeral head blood supply and maximize fracture fixation. A total of 34 patients with complex proximal humerus fractures were treated with a locking plate and endosteal implant through an anterolateral approach and followed for an average of 66 weeks to determine the rates of avascular necrosis.
  
  
  RESULTS
  No patient suffered complete osteonecrosis (0%) and only one patient suffered partial necrosis (2.8%) of the humeral head. The length of the posteromedial hinge was not predictive of this complication.
  
  
  CONCLUSIONS
  Use of the anterolateral approach and endosteal augment of a lateral locking plate can minimize avascular necrosis following proximal humerus fracture.
authors.affiliation: Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY, USA. aneviaser@gmail.com
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Neviaser
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Hettrich
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Dines
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D010020:Osteonecrosis / Q000453:epidemiology* / Q000209:etiology; D019736:Prostheses and Implants / Q000009:adverse effects; D012784:Shoulder Fractures / Q000601:surgery*