title: Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?
abstract: BACKGROUND
  The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation.
  
  
  METHODS
  Sixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer's evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression.
  
  
  RESULTS
  There were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer's criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%).
  
  
  CONCLUSIONS
  In the treatment of unstable proximal humerus fractures with locking plate technology and suture augmentation, we suggest that obtaining medial support is an important factor in preventing major bone- and fracture-related postoperative complications such as reduction loss or nonunion.
authors.affiliation: Department of Orthopaedic Surgery, Chonnam National University College of Medicine, 671, Jebong-Ro, Dong-Gu, Gwangju, 501-757, South Korea.
authors.forename: Woo-Bin
authors.initials: WB
authors.lastname: Jung
authors.forename: Eun-Sun
authors.initials: ES
authors.lastname: Moon
authors.forename: Sung-Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: David
authors.initials: D
authors.lastname: Kovacevic
authors.forename: Myung-Sun
authors.initials: MS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult