alexa Pitfalls and complications with locking plate for proximal humerus fracture.


Journal of Trauma & Treatment

Author(s): Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF

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Abstract PURPOSE: The aim of this study was to identify specific complications of locking plate fixation of proximal humerus fractures. PATIENTS AND METHODS: Seventy-three adult patients with a displaced 3- (24\%) or 4-part (76\%) fracture of the proximal humerus were treated over a period of 2 years under the supervision of a trauma surgeon. Fourty-four patients came back for a clinical and radiographic examinations at least 18 months after the trauma; the others were evaluated at 6 weeks and 3 and 6 months. RESULTS: Out of the 73 patients (64.4\% females, mean age of 65), 11 patients needed a second surgery and 18 were lost for follow-up after 6 months. Mean final constant score was 62.3 points. The incidence of secondary displacement was 8.2\%. Nonunion rate was 5.5\%, affecting the constant score (P = .018). 16.4\% of the patients developed a partial necrosis of the humeral head at the latest follow-up, which influenced on the constant score (P = .029). Quality of the reduction of the greater tuberosity influenced final results (P = .037). Screw cutout rate was 13.7\%, with an influence to the constant score (P = .001). A too high plate positioning influenced the constant score (P = .002). CONCLUSION: Locked screw-plates provide more secure fixation of fractures, especially in weak bone. Complications rate remains high. Two complications are to be distinguished: 1) technical complications in plate positioning, length of the screws or secondary screw cutout strongly influence the final clinical result; and 2) specific complications related to this technology such as pseudarthrosis or plate fracture. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved. This article was published in J Shoulder Elbow Surg and referenced in Journal of Trauma & Treatment

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