title: Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures.
abstract: OBJECTIVE
  The aim of this study was to evaluate risk factors for the development of humeral head necrosis and non-union after proximal humeral fractures-in particular, general risk factors that exist independent of fracture type.
  
  
  METHODS
  This study included patients (n=154) treated for proximal humeral fracture by means of open reduction and internal fixation (ORIF) using the Philos plate at a single level I trauma centre between January 2005 and December 2013. Follow-up monitoring included radiographic examination before hospital discharge, and again at 6 weeks, 12 weeks, and 6 months after surgery. At a minimum follow-up time of 6 months, radiographs taken in the anteroposterior and axial projection were evaluated in regard to the development of humeral head necrosis, non-union, and secondary screw cut out.
  
  
  RESULTS
  A total of 154 patients (61 males, 93 females) were available for radiological checkup. Mean age was 55.8 years (range: 19-91 years). There were statistically significant correlations between the development of avascular necrosis (AVN) and fracture type, non-union and smoking, and screw cut out - as well as overall complication rate - and age. The time to surgery did not influence the risk for AVN or non-union, independent of fracture type. In this study population, the risk of developing non-union after ORIF was 3.9-fold higher in heavy smokers (i.e., >20 cigarettes per day). The risk for screw cut out was 4.1-fold higher in patients over 60 years of age, and the overall risk for complications was 3.3-fold higher.
  
  
  CONCLUSIONS
  The older the patient, the more carefully one must consider the decision between conservative and operative treatments. If surgical treatment is performed, screw length should be selected depending on the patient's age. Heavy smokers must be informed preoperatively of the increased risk for bony non-union after ORIF.
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Electronic address: sandra.boesmueller@meduniwien.ac.at.
authors.forename: Sandra
authors.initials: S
authors.lastname: Boesmueller
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Margit
authors.initials: M
authors.lastname: Wech
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Gregori
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Domaszewski
authors.affiliation: Medical University of Vienna, Division of General Anaesthesia and Intensive Care Medicine, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Adam
authors.initials: A
authors.lastname: Bukaty
authors.affiliation: AUVA Trauma Center Vienna Meidling, Kundratstraße 37, A-1120 Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Fialka
authors.affiliation: Medical University of Vienna, Department of Trauma Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Albrecht
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
keywords: Avascular humeral head necrosis; Non-union; Plating; Proximal humeral fracture; Risk factors; Screw cut out