title: Which parameters affect medium- to long-term results after angular stable plate fixation for proximal humeral fractures?
abstract: BACKGROUND
  Very little information on medium- to long-term results is available for surgically treated proximal humeral fractures. The aim of this prospective treatment study was to present long-term results after angular stable plate fixation of displaced proximal humeral fractures and to detect which specific patient- and fracture-related parameters affect the clinical outcome.
  
  
  METHODS
  We performed a prospective clinical and radiologic evaluation of 77 patients with a displaced proximal humeral fracture (28 Neer 2-part, 38 3-part, and 11 4-part fractures; 28 AO A fractures, 30 AO B fractures, and 19 AO C fractures) treated with angular stable plate fixation after a mean follow-up period of 96 months (range, 74-133 months). We assessed outcomes with the Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and evaluated specific patient- and fracture-related parameters including complications.
  
  
  RESULTS
  The mean Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 79, 31, and 12 points. Reasons for revisions were implant-related impingement (n = 13), screw perforation (n = 10), infection (n = 4), and secondary fracture displacement (n = 1). There was a significant association between worse score results and occurrence of secondary fracture displacement, screw perforation, residual bone deformities, and a rotator cuff defect at follow-up.
  
  
  CONCLUSIONS
  Good medium- to long-term results after angular stable plate fixation of displaced proximal humeral fracture can be expected. A reconstruction within a range of 15° in both anteroposterior and axillary views and <5-mm tuberosity displacement should be the aim of head-preserving surgery to prevent complications, such as secondary fracture displacement and screw perforation, and a less favorable long-term result.
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany. Electronic address: C.Bahrs@gmx.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bahrs
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Luise
authors.initials: L
authors.lastname: Kühle
authors.affiliation: Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Rolauffs
authors.affiliation: Clinic for Traumatology and Reconstructive Surgery, Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität, Tübingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Freude
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D019534:Shoulder Impingement Syndrome / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Proximal humeral fracture; angular stable plate; complication; shoulder fractures; surgery; treatment