title: Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome.
abstract: BACKGROUND
  Locking plates for open reduction-internal fixation (ORIF) of proximal humeral fractures are widely used. We observed an unusually high number of patients with complications referred to our institution. It was the purpose of this study to report these complications, as well as their treatment and outcome.
  
  
  METHODS
  From 2003 to 2010, all patients treated for complications after ORIF with locking plates for proximal humeral fractures were prospectively collected and retrospectively analyzed. Patients were followed up clinically and radiographically.
  
  
  RESULTS
  In total, 121 patients (67 women and 54 men; mean age, 59 years) were referred after primary locking plate ORIF; 80% had a 3- or 4-part fracture. A mean of 3 complications occurred per patient, including malreduction, primary screw cutout, malunion, nonunion, avascular necrosis, and infection. Secondary screw cutout was found in 57% of patients, causing glenoid destruction in 33% of patients. A mean of 1.5 revision surgeries were needed. Hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty improved the mean Constant score (24 to 55 points, P < .05; 29 to 54 points, P = .3; and 25 to 48 points, P < .05, respectively) after a mean of 24 months. In 6 patients, glenoid implantation was no longer possible because of the destruction by perforated head screws.
  
  
  CONCLUSIONS
  In this negatively selected series, complications resulted in secondary arthroplasties in over 50% of the patients. Shoulder function, though improved, remained substantially restricted even after revision surgery. Glenoid destruction by locking screws was the most devastating and previously almost unseen complication, which limited the options of treatment.
authors.affiliation: Department of Orthopaedics, University Hospital Balgrist, Zürich, Switzerland. bernhard.jost@kssg.ch
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jost
authors.forename: Christian
authors.initials: C
authors.lastname: Spross
authors.forename: Holger
authors.initials: H
authors.lastname: Grehn
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult