title: Initial varus displacement of proximal humerus fractures results in similar function but higher complication rates.
abstract: OBJECTIVE
  To investigate the effect of initial varus or valgus surgical neck alignment on outcomes of patients who sustained proximal humerus fractures treated with open reduction and internal fixation (ORIF).
  
  
  METHODS
  An institutional review board approved database of proximal humerus fractures treated with locked plates was reviewed. Of 185 fractures in the database, 101 fractures were identified and met inclusion criteria. Initial varus displacement was seen in 47 fractures (OTA types 11.A2.2, A3.1, A3.3, B1.2, B2.2, C1.2, C2.2, or C2.3) and initial valgus displacement was observed in 54 fractures (OTA types 11.A2.3, B1.1, C1.1, or C2.1). All patients were treated in a similar manner and examined by the treating physician at standard intervals. Functional outcomes were quantified via the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and physical examination data at 12 months. Radiographs were reviewed for complications of healing. Additionally, complication rate and reoperation rate were investigated.
  
  
  RESULTS
  Patients who presented with initial varus displacement had an average age of 59.3 years, while patients in the valgus group had an average age of 62.4 years. Overall, there was no statistically significant difference in age, sex distribution, BMI, fracture parts, screws used, or implant plate type between the two groups. At a minimum 12 months follow up, there was no significant difference in DASH scores between those presenting with varus versus valgus fracture patterns. In addition, no significant differences were seen in final shoulder range of motion in any plane. Overall, 30 patients included in this study developed a complication. A significantly greater number of patients in the initial varus cohort developed complications (40.4%), as compared to 20.3% of patients in the initial valgus cohort (P=0.03). Fourteen patients in this study underwent reoperation. Nine of these patients were in the varus cohort, while 5 were in the valgus cohort (P=0.15).
  
  
  CONCLUSIONS
  In this study, initial surgical neck displacement in varus or valgus was found to not significantly affect functional outcome. Based upon our findings, patients with varus displaced proximal humerus fractures are at a greater risk of developing postoperative complications than those who present with initial valgus displaced fracture patterns.
authors.affiliation: NYU Hospital for Joint Diseases, United States.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Capriccioso
authors.affiliation: NYU Hospital for Joint Diseases, United States.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
authors.affiliation: NYU Hospital for Joint Diseases, United States; Jamaica Hospital Medical Center, United States. Electronic address: Kennth.Egol@nyumc.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data*; D012784:Shoulder Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States
keywords: Locking plate; Proximal humerus fracture; Valgus displacement; Varus displacement