title: Surgical management of complex proximal humeral fractures: pinning, locked plate and arthroplasty : Clinical results and functional outcome on retrospective series of patients.
abstract: OBJECTIVE
  The aim of the study was to compare the clinical results and related complications of four different surgical treatments of complex proximal humeral fractures according to their classification and features of patients.
  
  
  METHODS
  Between 2007 and 2011, 92 consecutive patients with diagnosis of three-four-part displaced fractures, fractures with head dislocation and head-splitting fractures were evaluated postoperatively with Constant-Murley score, disability of arm, shoulder and hand score and simple shoulder test.
  
  
  RESULTS
  All the treatment modalities showed from optimal to good mean functional results. The statistical analysis comparing each treatment group showed better outcomes scores (p < 0.05) for: locked plating versus HA, locked plating versus RSA and RSA versus HA. No differences between postoperative range of motion, complication rate and overall revision rate of the treatment groups were found at the end of follow-up (p > 0.05). Overall complication rate of surgical treatment of complex PHF was 31.5% (29 patients) with overall revision rate of 14.1%. Among patients with complications 77.8% of HA (7 of 9) required revision surgery (p < 0.05).
  
  
  CONCLUSIONS
  The treatment of complex PHF is nowadays a challenge even for skilled shoulder surgeons. The several viable operative options give good results whenever used for the correct indication. The range of reported complications from 18.2 to 37.5% remains concerning, but most of them did not affect clinical outcome in this series. Accurate preoperative characterization of the fracture pattern is necessary, and high surgical skills of the different operative techniques, including arthroplasty, are recommended to meet the increased functional expectations of patients.
  
  
  METHODS
  Therapeutic series, Level IV.
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Repetto
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy. mattia.alessio@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Alessio-Mazzola
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cerruti
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Sanguineti
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Formica
authors.affiliation: Department of Surgical Sciences (DISC), Orthopaedic Clinic, Pad. 40, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Felli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: PHILOS plate; Pinning technique; Proximal humeral fracture; Reverse shoulder arthroplasty; Shoulder hemiarthroplasty; Surgical treatment