title: Elective implant removal in symptomatic patients after internal fixation of proximal humerus fractures improves clinical outcome.
abstract: BACKGROUND
  Operative treatment is the standard for severely displaced proximal humerus fractures, but functional impairment can persist. Retaining of the implant can be a reason and in other fracture situations has proved to ameliorate patient satisfaction. The aim of this study was to analyse the functional outcome after locking plate removal in proximal humerus fractures.
  
  
  METHODS
  In a two-year period, all symptomatic patients with plate osteosynthesis for proximal humerus fracture and hardware removal were retrospectively evaluated clinically and radiologically pre- and post-implant removal. Evaluation included Constant score, height of plate position and possible impingement, as well as intraoperative complications.
  
  
  RESULTS
  Twenty patients met the inclusion criteria. The mean age was 56 ± 12 years. The plates were placed 6.9 ± 3 mm distal to the greater tubercle. The operation was performed in 35 ± 10 min and no intraoperative complications were reported. The Constant score improved significantly after implant removal from 71 to 76 (p = 0.008).
  
  
  CONCLUSIONS
  Symptomatic patients after locked plate osteosynthesis for proximal humerus fractures showed statistically significant improvement of the Constant score after implant removal.
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, CH-7000, Chur, Switzerland. yvespascal.acklin@gmail.com.
authors.forename: Yves P
authors.identifier: http://orcid.org/0000-0003-3751-7639
authors.initials: YP
authors.lastname: Acklin
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, CH-7000, Chur, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Michelitsch
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, CH-7000, Chur, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sommer
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Implant removal; Outcome; Philos plate