title: Complications of locked plating for proximal humeral fractures-are we getting any better?
abstract: BACKGROUND
  Complication rates reported after locking plate fixation of proximal humeral fractures still range up to 40%. Whether modifications of surgical techniques, use of primary shoulder arthroplasty, or a fracture-specific management resulted in decreased complication rates during recent years remains unclear. Therefore, the aim of this long-term observation study was to analyze the incidence of complications and revision surgery after locked plating.
  
  
  METHODS
  Between February 2002 and December 2013, 788 patients (aged 67.4 ± 17.3 years) with displaced proximal humeral fractures were treated with locking plate, primary hemiarthroplasty (HA), or reverse shoulder arthroplasty (RSA). Standardized follow-up included radiographs at 1 day, 6 weeks, and 3, 6, and 12 months. Complications and unplanned revision surgery were prospectively recorded over the complete follow-up.
  
  
  RESULTS
  Of 788 patients, 646 (82%) were treated with locking plate, 82 (10.4%) with HA, and 60 (7.6%) with RSA. Mean follow-up was 14.8 ± 3.8 months. The mean complication rate associated with locked plating was 12.8%, and revision surgery was necessary in 11.6%. Within the last 5 years, the loss of fixation rate markedly decreased from 14.3% to 4.8%; simultaneously, an increased use of RSA was observed.
  
  
  CONCLUSIONS
  The overall complication rate of locking plate osteosynthesis for proximal humeral fractures has been decreasing considerably within the last years. Among others, this might be due to an increased use of primary RSA for complex fracture types. In addition to a precise surgical technique, choosing the adequate treatment for each individual fracture to avoid complications and revision surgery is of utmost importance.
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany; Department of Knee, Hip and Shoulder Surgery, Schön-Klinik Munich-Harlaching, Munich, Germany. Electronic address: f.haasters@web.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Haasters
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Siebenbürger
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Helfen
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Daferner
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Böcker
authors.affiliation: Department of Trauma Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
authors.forename: Ben
authors.initials: B
authors.lastname: Ockert
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder; D001860:Bone Plates / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data / Q000639:trends; D012784:Shoulder Fractures / Q000601:surgery*
keywords: complication, revision; locked plating; long-term; outcome; primary arthroplasty; proximal humeral fracture