title: Medial calcar support and radiographic outcomes of plate fixation for proximal humeral fractures.
abstract: Plate fixation remains one of the most popular surgical procedures for treating proximal humeral fractures (PHFx); however, substantial rates of complications have been reported in the literature. The objectives of the study were to examine how medial calcar support (MCS) affects the radiographic outcomes and to determine the prognostic factors predicting treatment failure. We performed a retrospective cohort study of 89 adult patients who had PHFx and were treated with plate fixation at our institution in 2007-2011. The enrolled patients were separated into two groups according to disruption of medial calcar. Our results revealed an increased rate of poor radiographic outcomes in patients with disrupted medial calcar. Osteonecrosis of the humeral head and redisplacement were the two radiographic outcomes which had a positive causality with disruption of medial calcar (P = 0.008 and 0.050, resp.). Deficient medial calcar, inadequate reduction, diabetes mellitus, chronic kidney disease, and chronic liver disease were all significant predictors for the development of osteonecrosis in patients after PHFx surgery. Inadequate reduction was also a predictor for redisplacement. We confirmed that the restoration of medial calcar as well as comorbid conditions plays key roles in treatment of patients having PHFx with disrupted medial calcar.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan.
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan ; College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Yao-Hung
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan.
authors.forename: Tien-Yu
authors.initials: TY
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan.
authors.forename: Shih-Hsun
authors.initials: SH
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan ; College of Medicine, Chang Gung University, Taoyuan City, Taiwan ; Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi City, Taiwan ; College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000601:surgery; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery